title: Effects of a short course of inhaled corticosteroids in noneosinophilic asthmatic subjects.
abstract: BACKGROUND
  Noneosinophilic asthma has been regarded as a distinct phenotype characterized by a poor response to inhaled corticosteroids (ICS).
  
  
  OBJECTIVE
  To determine whether noneosinophilic, steroid-naive asthmatic subjects show an improvement in asthma control, asthma symptoms and spirometry after four weeks of treatment with ICS, and whether they further benefit from the addition of a long-acting beta-2 agonists to ICS.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled, multicentre study comparing the efficacy of placebo versus inhaled fluticasone propionate 250 mcg twice daily for four weeks in mildly uncontrolled, steroid-naive asthmatic subjects with a sputum eosinophil count of 2% or less. This was followed by an open-label, four-week treatment period with fluticasone propionate 250 mcg⁄salmeterol 50 mcg, twice daily for all subjects.
  
  
  RESULTS
  After four weeks of double-blind treatment, there was a statistically significant and clinically relevant improvement in the mean (± SD) Asthma Control Questionnaire score in the ICS-treated group (n = 6) (decrease of 1.0 ± 0.5) compared with the placebo group (n = 6) (decrease of 0.09 ± 0.4) (P = 0.008). Forced expiratory volume in 1 s declined in the placebo group (-0.2 ± 0.2 L) and did not change in the ICS group (0.04 ± 0.1 L) after four weeks of treatment (P = 0.02). The open-label treatment with fluticasone propionate 250 mcg⁄salmeterol 50 mcg did not produce additional improvements in those who were previously treated for four weeks with inhaled fluticasone alone.
  
  
  CONCLUSIONS
  A clinically important and statistically significant response to ICS was observed in mildly uncontrolled noneosinophilic asthmatic subjects.
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec. catherine.lemiere@umontreal.ca
authors.forename: Catherine
authors.initials: C
authors.lastname: Lemière
authors.forename: Caroline
authors.initials: C
authors.lastname: Tremblay
authors.forename: Mark
authors.initials: M
authors.lastname: FitzGerald
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Aaron
authors.forename: Richard
authors.initials: R
authors.lastname: Leigh
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
authors.forename: James G
authors.initials: JG
authors.lastname: Martin
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Nair
authors.forename: Ronald
authors.initials: R
authors.lastname: Olivenstein
authors.forename: Simone
authors.initials: S
authors.lastname: Chaboillez
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control; D004311:Double-Blind Method; D004338:Drug Combinations; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012129:Respiratory Function Tests; D013147:Spirometry; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; D000420:Albuterol