Evaluation of surrogate inflammatory markers for optimizing inhaled corticosteroid therapy in a real-life clinical setting

Abstract

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.