title: Benefits of low-dose inhaled fluticasone on airway response and inflammation in mild asthma.
abstract: BACKGROUND
  Current guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required.
  
  
  OBJECTIVE
  To evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma.
  
  
  METHODS
  In this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250 microg/day for 3 months followed by 100 microg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit.
  
  
  RESULTS
  Fifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC20 methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n=33) and in fluticasone-treated (n=24) asthmatic subjects (p=0.03). An additional improvement in PC20 up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p=0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250 microg/day compared with placebo (p<0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups.
  
  
  CONCLUSIONS
  In mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range.
authors.affiliation: Unité de recherche en pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec8, PQ, Canada G1V 4G5. lpboulet@med.ulaval.ca
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
authors.forename: Hélène
authors.initials: H
authors.lastname: Turcotte
authors.forename: Philippe
authors.initials: P
authors.lastname: Prince
authors.forename: Catherine
authors.initials: C
authors.lastname: Lemière
authors.forename: Ronald
authors.initials: R
authors.lastname: Olivenstein
authors.forename: Catherine
authors.initials: C
authors.lastname: Laprise
authors.forename: Pierre
authors.initials: P
authors.lastname: Larivée
authors.forename: Paul
authors.initials: P
authors.lastname: Bégin
authors.forename: Michel
authors.initials: M
authors.lastname: Laviolette
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D055815:Young Adult
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone