"Refractory" Eosinophilic Airway Inflammation in Severe Asthma: Effect of Parenteral Corticosteroids
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 sti...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2004-09, Vol.170 (6), p.601-605 |
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| creator | ten Brinke, Anneke Zwinderman, Aeilko H Sterk, Peter J Rabe, Klaus F Bel, Elisabeth H |
| description | 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 (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 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. |
| doi_str_mv | 10.1164/rccm.200404-440OC |
| format | Article |
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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 (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 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.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.200404-440OC</identifier><identifier>PMID: 15215154</identifier><language>eng</language><publisher>New York, NY: Am Thoracic Soc</publisher><subject>Adrenal Cortex Hormones - administration & dosage ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. 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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 (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 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). 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Cell therapy and gene therapy</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Asthma - drug therapy</subject><subject>Asthma - immunology</subject><subject>Biological and medical sciences</subject><subject>Breath Tests</subject><subject>Cohort Studies</subject><subject>Dose-Response Relationship, Drug</subject><subject>Double-Blind Method</subject><subject>Eosinophilia - immunology</subject><subject>Female</subject><subject>Humans</subject><subject>Injections, Intramuscular</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nitric Oxide - analysis</subject><subject>Respiratory Function Tests</subject><subject>Severity of Illness Index</subject><subject>Sputum - immunology</subject><subject>Treatment Outcome</subject><subject>Triamcinolone - administration & dosage</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkVFrFDEQxxdRbK1-AF8kHCj4sDWzm-QS347jtIVCpSr4FmaziZcju7kme5b79s15B4U-ZUJ-88_wm6p6D_QSQLAvyZjhsqGUUVYzRm-XL6pz4C2vmZrTl6Wm87Y8qD9n1ZucN5RCI4G-rs6AN8CBs_Oqn91Zl9BMMe1nZBWzH-N27YM3ZOHTA-7J9egCDgNOPo7Ej-Sn_WeTJYs8rQf8SlbOWTOR6MgPTHacbMJAljFN3sRcbtH3-W31ymHI9t3pvKh-f1v9Wl7VN7ffr5eLm9q0jE61lFJJYM60sjFdZ0F0nPcduqZrODTWIAKAkWKOHXZcSjCNMj0qoSRjpm8vqk_H3G2K9zubJz34bGwIONq4y1oIyUUxV8DZM3ATd2kss2lQiitWJikQHCGTYs7JOr1NfsC010D1wb8--NdH__q__9Lz4RS86wbbP3WchBfg4wnAbDAU9aPx-YkTVJXlNYX7fOTW_u_6wSer84AhlFjQuDl8DHOqhRYU2keo0J11</recordid><startdate>20040915</startdate><enddate>20040915</enddate><creator>ten Brinke, Anneke</creator><creator>Zwinderman, Aeilko H</creator><creator>Sterk, Peter J</creator><creator>Rabe, Klaus F</creator><creator>Bel, Elisabeth H</creator><general>Am Thoracic Soc</general><general>American Lung Association</general><general>American Thoracic Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20040915</creationdate><title>"Refractory" Eosinophilic Airway Inflammation in Severe Asthma: Effect of Parenteral Corticosteroids</title><author>ten Brinke, Anneke ; Zwinderman, Aeilko H ; Sterk, Peter J ; Rabe, Klaus F ; Bel, Elisabeth H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-8889814fc382cbbe16b55dbaf2b2512ecaa111c867abab5881c29cda969844cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anti-Inflammatory Agents - administration & dosage</topic><topic>Asthma - drug therapy</topic><topic>Asthma - immunology</topic><topic>Biological and medical sciences</topic><topic>Breath Tests</topic><topic>Cohort Studies</topic><topic>Dose-Response Relationship, Drug</topic><topic>Double-Blind Method</topic><topic>Eosinophilia - immunology</topic><topic>Female</topic><topic>Humans</topic><topic>Injections, Intramuscular</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nitric Oxide - analysis</topic><topic>Respiratory Function Tests</topic><topic>Severity of Illness Index</topic><topic>Sputum - immunology</topic><topic>Treatment Outcome</topic><topic>Triamcinolone - administration & dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ten Brinke, Anneke</creatorcontrib><creatorcontrib>Zwinderman, Aeilko H</creatorcontrib><creatorcontrib>Sterk, Peter J</creatorcontrib><creatorcontrib>Rabe, Klaus F</creatorcontrib><creatorcontrib>Bel, Elisabeth H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ten Brinke, Anneke</au><au>Zwinderman, Aeilko H</au><au>Sterk, Peter J</au><au>Rabe, Klaus F</au><au>Bel, Elisabeth H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>"Refractory" Eosinophilic Airway Inflammation in Severe Asthma: Effect of Parenteral Corticosteroids</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2004-09-15</date><risdate>2004</risdate><volume>170</volume><issue>6</issue><spage>601</spage><epage>605</epage><pages>601-605</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>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 (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 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.</abstract><cop>New York, NY</cop><pub>Am Thoracic Soc</pub><pmid>15215154</pmid><doi>10.1164/rccm.200404-440OC</doi><tpages>5</tpages></addata></record> |
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| subjects | Adrenal Cortex Hormones - administration & dosage Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anti-Inflammatory Agents - administration & dosage Asthma - drug therapy Asthma - immunology Biological and medical sciences Breath Tests Cohort Studies Dose-Response Relationship, Drug Double-Blind Method Eosinophilia - immunology Female Humans Injections, Intramuscular Intensive care medicine Male Medical sciences Middle Aged Nitric Oxide - analysis Respiratory Function Tests Severity of Illness Index Sputum - immunology Treatment Outcome Triamcinolone - administration & dosage |
| title | "Refractory" Eosinophilic Airway Inflammation in Severe Asthma: Effect of Parenteral Corticosteroids |
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