title: Bronchodilator response as a hallmark of uncontrolled asthma: a randomised clinical trial.
abstract: BACKGROUND
  The goal of this study is to determine whether bronchodilator (BD) response can be used as a reliable measure of asthma control by analyzing the effects of a short course of oral corticosteroids (OC) or placebo (P) on spirometry, sputum cytology and BD response in controlled asthma patients scoring less than 1.5 on the ACQ5.
  
  
  METHODS
  Seventy patients with moderate to severe asthma who were undergoing combination therapy and were considered to be controlled based on ACQ5 scores, but who exhibited persistent positive BD response, were randomly assigned to two groups, one receiving OC and the other P. Patients were evaluated before and after 2 weeks of treatment. Intervention response (comparison of FEV(1) before and after OC or P treatment) was used as a measure of intervention efficacy, with values equal to or greater than 200 mL considered positive.
  
  
  RESULTS
  Patients who received OC showed significant improvement in FEV(1), and no longer exhibited a positive BD response. Those in the P group showed no change. In addition, sputum eosinophil counts significantly decreased in the OC group.
  
  
  CONCLUSIONS
  BD response can be used as a reliable measure of asthma control. This study suggests that ACQ5 scores alone are not sufficient to fully assess asthma control, and that BD response should be included as an essential measurement in any algorithm of asthma control evaluation.
authors.affiliation: Respiratory Division, Universidade Federal de São Paulo/Escola Paulista de Medicina , São Paulo-SP , Brasil.
authors.forename: Ana Luisa Godoy
authors.initials: AL
authors.lastname: Fernandes
authors.forename: Maria Marta
authors.initials: MM
authors.lastname: Amorim
authors.forename: Lilian Ballini
authors.initials: LB
authors.lastname: Caetano
authors.forename: Samir
authors.initials: S
authors.lastname: Dracoulakis
authors.forename: Alexandre Augusto Ramalho
authors.initials: AA
authors.lastname: Araruna
authors.forename: Sonia Maria
authors.initials: SM
authors.lastname: Faresin
authors.forename: Ilka Lopes
authors.initials: IL
authors.lastname: Santoro
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods; D013183:Sputum / Q000166:cytology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents