title: Proof of concept study to evaluate step-down therapy with inhaled corticosteroid alone or additive therapy on surrogate inflammatory markers in asthma.
abstract: BACKGROUND
  Much of the focus of inflammatory surrogates and airway challenges in asthma has been directed towards success of therapy and diagnosis. Few have considered them in the context of guiding dose reduction once sufficient control has been achieved.
  
  
  CONCLUSIONS
  Adenosine monophosphate (AMP) as an indirect bronchial airway challenge, together with non invasive inflammatory surrogate measures were not found to be clinically useful when guiding therapy in a group of asthmatic patients through step 3-4 in British Thoracic Society asthma guidelines. However, they may still play a role in predicting failure of individual step-down.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the usefulness of inflammatory surrogates in determining step-down therapy in asthma.
  
  
  METHODS
  AMP challenge, serum eosinophil cationic protein (ECP), exhaled nitric oxide (eNO) and pulmonary function tests were recorded. Subjects were divided into two groups following high dose inhaled corticosteroids (ICS): Group A fixed dose ICS vs. Group B ICS alone and in combination with add on therapies.
  
  
  RESULTS
  No differences were seen in inflammatory measures between fixed dose ICS and reduced dose ICS alone or with combination therapies.
  
  
  CONCLUSIONS
  AMP challenge conferred no additional benefit in guiding step-down therapy. The role of inflammatory surrogates may still play a role in predicting failed step-down on an individual basis.
authors.affiliation: Asthma and Allergy Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: McKinlay
authors.forename: Peter A
authors.initials: PA
authors.lastname: Williamson
authors.forename: Philip M
authors.initials: PM
authors.lastname: Short
authors.forename: Tom C
authors.initials: TC
authors.lastname: Fardon
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lipworth
mesh_terms: D000249:Adenosine Monophosphate; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D015415:Biomarkers; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D047150:Eosinophil Cationic Protein; D006801:Humans; D009569:Nitric Oxide; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide; D000249:Adenosine Monophosphate; D047150:Eosinophil Cationic Protein