PT  - JOURNAL ARTICLE
AU  - William Anderson
AU  - Philip Short
AU  - Peter Williamson
AU  - Brian Lipworth
TI  - Effects of inhaled corticosteroids on asthmatic inflammation: The FeNOtype trial
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - P2088
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/P2088.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/P2088.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - BACKGROUND: Personalised treatment for inflammatory asthma phenotypes confers superior benefits. The elevated exhaled nitric oxide (FeNO) inflammatory phenotype requires evaluation of dose-response to inhaled corticosteroids (ICS).METHODS: Randomised, crossover trial in mild-to-moderate asthmatics receiving ICS with elevated FeNO>40ppb after ICS washout. Patients received 2 weeks of: fluticasone propionate 50ug twice-daily (FP100) or 250ug twice-daily (FP500). Primary outcome: response in diurnal domiciliary FeNO levels. Secondary outcomes included: mannitol challenge; serum eosinophilic cationic protein (ECP); blood eosinophil count; and asthma control questionnaire (ACQ).RESULTS: 21 patients completed. We found significant dose-related reductions of diurnal FeNO compared to baseline: am FeNO: baseline=71ppb; FP100=34ppb, p<0.001; FP500=27ppb, p<0.001; and significant dose separation for am, p<0.05, and pm, p<0.001. Time series FeNO displayed exponential decay:ACQ significantly improved exceeding the minimal important difference (>0.5) with values in keeping with controlled asthma (<0.75) after each dose: FP100=0.48, p=0.004; FP500=0.37, p=0.001. All other secondary inflammatory related outcomes showed significant improvements from baseline but no dose separation.CONCLUSION: There is significant, dose-response of diurnal FeNO to ICS in patients with a high FeNO phenotype, also associated with well controlled asthma.