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Surrogate markers apart from serum ECP may be used as a guide to evaluate the anti-inflammatory effects of low dose inhaled corticosteroids. Sputum markers tend to be more sensitive than blood when assessing the anti-inflammatory response.

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Background:  To determine the effects of 1 months treatment with optimized high‐dose inhaled cortico­steroid on surrogate markers of airways inflammation, as well as lung function, in a clinical setting. Methods:  Nine steroid‐treated asthmatics (mean dose 778 µg/day) with uncontrolled disease were all switched to 1 months treatment with 2000 µg/day inhaled beclomethasone dipropionate dry powder. Serial spot clinic measurements were made of pre‐ and post‐treatment effects on sputum eosinophils, serum eosin­ophil cationic protein (ECP), bronchial hyper­responsiveness (BHR) to methacholine, exhaled nitric oxide (NO), spirometry and domiciliary peak expiratory flow rate (PEF), symptom score and reliever use. Results:  Optimization of inhaled corticosteroid treatment had further significant (P < 0.05) beneficial effects only on sputum eosinophils, BHR, symptom score and morning PEF. Furthermore, treatment decreased the eosinophil count in all cases. Conclusions:  Serial clinic measurements of sputum eosinophils and BHR may provide additional information on asthmatic inflammation to assess the response to inhaled steroids in patients who have uncontrolled asthma.