Changes in sputum counts and airway hyperresponsiveness after budesonide: Monitoring anti-inflammatory response on the basis of surrogate markers of airway inflammation

Background: Airway hyperresponsiveness (AHR) to pharmacologic stimuli and sputum eosinophils might be useful in the individual adjustment of long-term asthma management. However, it is not clear whether inhaled glucocorticosteroids (GCSs) provide greater protection against specific surrogate markers...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2002-12, Vol.110 (6), p.855-861
Main Authors: Prosperini, Gaetano, Rajakulasingam, Kajakulasingam, Cacciola, Rossella R., Spicuzza, Lucia, Rorke, Steuart, Holgate, Stephen T., Di Maria, Giuseppe U., Polosa, Riccardo
Format: Article
Language:English
Subjects:
adenosine challenge
Adenosine Monophosphate - pharmacology
Adult
Asthma
Asthma - drug therapy
Asthma - physiopathology
Biological and medical sciences
Bronchial Hyperreactivity - drug therapy
Bronchial hyperresponsiveness
budesonide
Budesonide - therapeutic use
Cross-Over Studies
Double-Blind Method
Drug therapy
Female
Forced Expiratory Volume
Histamine and antagonists. Allergy
Humans
induced sputum
Male
Medical sciences
Methacholine Chloride - pharmacology
Middle Aged
Pharmacology. Drug treatments
Sputum - cytology
Studies
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Summary:Background: Airway hyperresponsiveness (AHR) to pharmacologic stimuli and sputum eosinophils might be useful in the individual adjustment of long-term asthma management. However, it is not clear whether inhaled glucocorticosteroids (GCSs) provide greater protection against specific surrogate markers of airways inflammation than other means. In addition, detailed longitudinal assessment of changes in airway response with inhaled GCSs has never been carried out. Objectives: We compared changes in AHR to inhaled methacholine and adenosine 5′-monophosphate (AMP) after budesonide treatment in a randomized, double-blind, placebo-controlled, crossover study of patients with mild-to-moderate asthma. Subsequently, we undertook a separate study to examine the time course of the changes in AHR in more detail and the changes in sputum cell counts in relation to budesonide treatment. Methods: In the phase 1 of the study, patients undertook bronchial provocation studies with increasing doubling concentrations of methacholine (0.06 to 16 mg/mL) and AMP (3.125 to 800 mg/mL) before and after budesonide 0.8 mg/daily for 3 weeks. The bronchial responses to the inhaled agonists were expressed as the provocative concentration causing a 20% decline in FEV1 (PC20). In phase 2 of the study, patients attended the laboratory on 12 separate occasions to investigate changes in PC20 methacholine, PC20 AMP, and sputum cell counts before, during, and after withdrawal of therapy with inhaled budesonide 0.8 mg/daily for 6 weeks. Results: Budesonide treatment for 3 weeks significantly attenuated the constrictor response by 0.8 ± 0.3 doubling doses for methacholine and by 2.6 ± 0.5 doubling doses for AMP. These changes were significantly different from each other (P = .003). Significant variation in PC20 methacholine (P < .05) value, PC20 AMP (P < .001) value, percentage of sputum eosinophils (P < .001), and percentage of sputum epithelial cells (P < .001) were observed throughout the longitudinal assessment of changes in airway response to budesonide. Compared with the other surrogate markers, PC20 AMP appears to be useful in promptly detecting early inflammatory changes of the asthmatic airways; a significant change of 1.6 ± 0.3, 2.2 ± 0.3, and 2.8 ± 0.3 doubling doses of PC20 AMP was observed at 1, 4, and 6 weeks, respectively, in the course of budesonide treatment. Conclusions: The present findings underline the exquisite selectivity of diverse surrogate markers of airway inflammation i
ISSN:0091-6749
1097-6825
DOI:10.1067/mai.2002.130050