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Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function

¹ Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland, ² Schering-Plough Corporation, Kenilworth, NJ, USA, ³ Semeco AB, Ängelholm, Sweden, ⁴ For members of the Airway Inflammation Study Group, see the Acknowledgements section.

CORRESPONDENCE: T. Haahtela, Skin and Allergy Hospital, Helsinki University Central Hospital, P.O.Box 160, FI-00029 Helsinki, Finland. Fax: 358 947186500. E-mail: tari.haahtela{at}hus.fi

Keywords: Airway inflammation, asthma symptoms, induced sputum, mometasone furoate, placebo

Received: May 23, 2007
Accepted May 8, 2008

A total of 144 patients with lower airway symptoms suggestive of asthma, but who did not fulfil the functional criteria of asthma, were included in a randomised, double-blind, placebo-controlled 8-week "proof-of-concept" study with mometasone furoate (MF), 400 µg once daily. The primary efficacy variable was the mean change from baseline in six morning and evening weekly symptom scores: cough, sputum production, wheeze, shortness of breath, chest tightness and exercise-induced cough/wheeze. Total symptom scores were calculated after treatment for 4 and 8 weeks.

Compared with placebo, MF improved total morning symptom score at 8 weeks. Changes in total evening symptom scores did not differ between treatments. MF improved all individual symptom scores more than placebo, although the differences in changes between treatments were not always statistically significant. Morning and evening peak expiratory flow rates increased with MF compared with placebo. MF reduced eosinophils and the levels of eosinophilic cationic protein in induced sputum.

The results show that symptoms suggestive of asthma exist in patients without significant β₂-agonist reversibility or diurnal variability in peak flow. Once-daily MF may benefit some of these patients and a short course with inhaled corticosteroids may be tried. Responders should be better identified in further studies.