RT Journal Article
SR Electronic
T1 Comparison of asthma treatment given in addition to inhaled corticosteroids on airway inflammation and responsiveness
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1144
OP 1151
DO 10.1183/09031936.06.00102605
VO 27
IS 6
A1 R. H. Green
A1 C. E. Brightling
A1 S. McKenna
A1 B. Hargadon
A1 N. Neale
A1 D. Parker
A1 C. Ruse
A1 I. P. Hall
A1 I. D. Pavord
YR 2006
UL http://erj.ersjournals.com/content/27/6/1144.abstract
AB There is increasing evidence that the assessment of eosinophilic airway inflammation using induced sputum and measurement of airway hyperresponsiveness provides additional, clinically important information concerning asthma control. The aim of this study was to directly compare the effects of different treatments on these markers in patients with asthma and persistent symptoms, despite the use of low-dose inhaled corticosteroids. A double-blind four-way crossover study was performed, which compared a 1-month treatment with budesonide 400 μg b.i.d., additional formoterol, additional montelukast and placebo in 49 patients with uncontrolled asthma despite budesonide 100 μg b.i.d., with each treatment separated by a 4-week washout period. The change in sputum eosinophil count with formoterol (2.4 to 3.8% change, 0.6-fold reduction, 95% confidence interval (CI) 0.5–0.9) differed significantly from placebo (2.8 to 2.5% change, 1.1-fold reduction, 95% CI 0.7–1.6) and high-dose budesonide (2.7 to 1.6% change, 1.6-fold reduction, 95% CI 1.2–2.2). The effects of montelukast did not differ from placebo. The changes in methacholine airway responsiveness were small and did not differ between treatments. High-dose budesonide had the broadest range of beneficial effects on other outcomes, including symptom scores, morning peak expiratory flow and forced expiratory volume in one second. In conclusion, treatment given in addition to low-dose inhaled corticosteroids results in modest benefits. Formoterol and high-dose budesonide have contrasting effects on eosinophilic airway inflammation.