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Published ahead of print on June 23, 2004, doi:10.1164/rccm.200404-440OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 601-605

A more recent version of this article appeared on September 15, 2004
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Submitted on April 1, 2004
Accepted on June 20, 2004

'Refractory' Eosinophilic Airway Inflammation in Severe Asthma; Effect of Parenteral Corticosteroids

Anneke ten Brinke1, Aeilko H Zwinderman2, Peter J Sterk3, Klaus F Rabe3, and Elisabeth H Bel3*

1 Department of Pulmonary Diseases, Leeuwarden Medical Center, Leeuwarden, The Netherlands, 2 Department of Biostatistics, Amsterdam Medical Center, Amsterdam, The Netherlands, 3 Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, The Netherlands

* To whom correspondence should be addressed. 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, age 21-73 yr) participated in this double-blind, placebo-controlled study. All were using inhaled corticosteroids (≥1600 mg/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 median 12.6% to 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 median 73.8 to 88.3 %pred. (p=0.001). We conclude that persistent sputum eosinophilia despite extensive anti-asthma 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 anti-inflammatory treatment to combat the eosinophilia and associated poor prognosis.
Key words: asthma, severity of illness index, prognosis, phenotype, eosinophilia, sputum, glucocorticoids, human




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