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a Department
of Pulmonology, b Department of
Cytology, c Department
of Medical Statistics, d Leiden
University Medical Center, Leiden, The Netherlands
Correspondence to: Professor P J Sterk, Lung Function Laboratory, C2-P Department of Pulmonology, Leiden University Medical Center, P O Box 9600, NL-2300 RC Leiden, The Netherlands.
Received 3 July 1998; Returned to authors 7 October 1998; Revised version received 13 November 1998; Accepted for publication 8 December 1998
BACKGROUND
Airway
hyperresponsiveness, induced sputum eosinophils, and exhaled nitric
oxide (NO) levels have all been proposed as non-invasive markers for
monitoring airway inflammation in patients with asthma. The aim of this
study was to compare the changes in each of these markers following
treatment with inhaled glucocorticosteroids in a single study.
METHODSIn a
randomised, double blind, placebo controlled, parallel study 25 patients with mild asthma (19-34 years, forced expiratory volume in
one second (FEV1) >75% predicted, concentration of
histamine provoking a fall in FEV1 of 20% or more
(PC20) <4 mg/ml) inhaled fluticasone propionate
(500 µg twice daily) for four weeks. PC20 to histamine,
sputum eosinophil numbers, and exhaled NO levels were determined at
weeks 0, 2, and 4, and two weeks after completing treatment. Sputum was
induced by inhalation of hypertonic (4.5%) saline and eosinophil
counts were expressed as percentage non-squamous cells. Exhaled NO
levels (ppb) were measured by chemiluminescence.
RESULTSIn the
steroid treated group there was a significant increase in
PC20, decrease in sputum eosinophils, and decrease in
exhaled NO levels compared with baseline at weeks 2 and 4 of treatment. Subsequently, each of these variables showed significant worsening during the two week washout period compared with week 4. These changes
were significantly different from those in the placebo group, except
for the changes in sputum eosinophils and exhaled NO levels during the
washout period. There were no significant correlations between the
changes in the three markers in either group at any time.
CONCLUSIONSTreatment
of asthmatic subjects with inhaled steroids for four weeks leads to
improvements in airway hyperresponsiveness to histamine, eosinophil
counts in induced sputum, and exhaled nitric oxide levels. The results
suggest that these markers may provide different information when
monitoring anti-inflammatory treatment in asthma.
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