title: Effect of inhaled corticosteroids on systemic inflammation in asthma.
abstract: BACKGROUND
  Recent research using serum high sensitivity C-reactive protein (hs-CRP) has evidenced existence of low grade systemic inflammation in asthmatics whose correlation with various clinical indices is not fully studied.
  
  
  OBJECTIVE
  To investigate the relationship between systemic inflammation and various clinical and treatment characteristics of asthma.
  
  
  METHODS
  Forty asthmatics (22 steroid inhaling and 18 steroid naïve) and 40 healthy subjects matched for age and sex were examined cross-sectionally. Along with clinical assessment, serum hs-CRP levels were measured for all subjects using latex enhanced immunoturbidometry method.
  
  
  RESULTS
  Serum hs CRP levels were significantly higher in steroid naïve asthmatics when compared to normal subjects (0.93 ± 1.18 vs 0.24 ± 0.31 mg/dL, respectively; Mann-Whitney U test, P < 0.001). This association persisted after adjusting for age, gender, body mass index (BMI), and socioeconomic status (adjusted odds ratio 10.47; 95% CI 1.88-58.3; P < 0.01). Steroid inhaling asthmatics had serum hs-CRP levels comparable with control group (0.17 ± 0.18 vs 0.24 ± 0.31 mg/dL respectively, P > 0.05). Among the clinical and treatment related variables, duration of inhaled steroids usage alone correlated significantly with serum hs-CRP levels (Pearson correlation coefficient r = 0.449, P < 0.05), which was independent of age, BMI, duration of illness, and frequency of emergency visits.
  
  
  CONCLUSIONS
  This study confirms the existence of low grade systemic inflammation in asthma which is effectively controlled by inhaled steroids. Such an effect of inhaled steroids appears to be more pronounced in recent users than that of long-term users, possibly due to lower adherence rate among the latter.
authors.affiliation: Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Ramaraju
authors.initials: R
authors.lastname: Karthikeyan
authors.affiliation: Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Smrithi
authors.initials: S
authors.lastname: Maamidi
authors.affiliation: Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Anupama Murthy
authors.initials: AM
authors.lastname: Kaza
authors.affiliation: Department of Respiratory Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Nithilavalli
authors.initials: N
authors.lastname: Balasubramanian
keywords: Asthma; high sensitivity C-reactive protein; inhaled steroids; systemic inflammation
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