Published ahead of print on June 23, 2004, doi:10.1164/rccm.200404-440OC
American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 601-605, (2004)
© 2004 American Thoracic Society
"Refractory" Eosinophilic Airway Inflammation in Severe Asthma
Effect of Parenteral Corticosteroids
Anneke ten Brinke,
Aeilko H. Zwinderman,
Peter J. Sterk,
Klaus F. Rabe and
Elisabeth H. Bel
Department of Pulmonary Diseases, Leeuwarden Medical Center, Leeuwarden; Department of Biostatistics, Amsterdam Medical Center, Amsterdam; and Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, The Netherlands
Correspondence and requests for reprints should be addressed to Elisabeth H. Bel, M.D., Ph.D., Department of Pulmonary Diseases, C3-P, Leiden University Medical Center, P.O. Box 9600, NL-2300 RC Leiden, The Netherlands. E-mail: e.h.d.bel{at}lumc.nl
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 ( 1,600 µg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal ( 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.
Key Words: asthma • eosinophilia • glucocorticoids • phenotype • sputum • severity of illness index
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Copyright © 2004 American Thoracic Society
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