TY - JOUR
T1 - "Refractory" eosinophilic airway inflammation in severe asthma - Effect of parenteral corticosteroids
AU - Zwinderman, Aeilko H.
AU - Sterk, Peter J.
AU - Rabe, Klaus F.
AU - Bel, Elisabeth H.
PY - 2004
Y1 - 2004
N2 - It has been suggested that patients with refractory eosinophilic airway inflammation represent a separate "eosinophilic" asthma phenotype associated with increased morbidity and a poor prognosis. To investigate whether persistent eosinophilia in these patients is a fixed feature or can still be modified by treatment, we investigated the effect of high-dose intramuscular corticosteroids on eosinophils in induced sputum. Twenty-two patients with stable severe asthma (15 women, aged 21-73 years) participated in this double-blind, placebo-controlled study. All were using inhaled corticosteroids (greater than or equal to 1,600 mug/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (greater than or equal to 2%). Two weeks after treatment with triamcinolone, but not placebo, sputum eosinophils almost completely disappeared from a median of 12.6-0.2% (p <0.001). In 82% of patients, no eosinophils could be observed at all. In addition, the rescue medication score decreased from 1.4 to 0.8 (p = 0.01), and FEV1 improved from a median of 73.8-88.3% predicted (p = 0.001). We conclude that persistent sputum eosinophilia despite extensive antiasthma treatment is not a refractory phenomenon but is still sensitive to high-dose systemic corticosteroids. This implies that these patients with severe asthma need additional or alternative antiinflammatory treatment to combat the eosinophilia and associated poor prognosis
AB - It has been suggested that patients with refractory eosinophilic airway inflammation represent a separate "eosinophilic" asthma phenotype associated with increased morbidity and a poor prognosis. To investigate whether persistent eosinophilia in these patients is a fixed feature or can still be modified by treatment, we investigated the effect of high-dose intramuscular corticosteroids on eosinophils in induced sputum. Twenty-two patients with stable severe asthma (15 women, aged 21-73 years) participated in this double-blind, placebo-controlled study. All were using inhaled corticosteroids (greater than or equal to 1,600 mug/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (greater than or equal to 2%). Two weeks after treatment with triamcinolone, but not placebo, sputum eosinophils almost completely disappeared from a median of 12.6-0.2% (p <0.001). In 82% of patients, no eosinophils could be observed at all. In addition, the rescue medication score decreased from 1.4 to 0.8 (p = 0.01), and FEV1 improved from a median of 73.8-88.3% predicted (p = 0.001). We conclude that persistent sputum eosinophilia despite extensive antiasthma treatment is not a refractory phenomenon but is still sensitive to high-dose systemic corticosteroids. This implies that these patients with severe asthma need additional or alternative antiinflammatory treatment to combat the eosinophilia and associated poor prognosis
U2 - https://doi.org/10.1164/rccm.200404-440OC
DO - https://doi.org/10.1164/rccm.200404-440OC
M3 - Article
C2 - 15215154
SN - 1073-449X
VL - 170
SP - 601
EP - 605
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 6
ER -