Analysis of induced sputum before and after withdrawal of treatment with inhaled corticosteroids in asthmatic patients

• Published in: Clinical and experimental allergy 2000-12, Vol.30 (12), p.1777-1784
• Main Authors: Giannini, D., Di Franco, A., Cianchetti, S., Bacci, E., Dente, F. L., Vagaggini, B., Paggiaro, P. L.
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adult; Allergic diseases; asthma; Asthma - drug therapy; Asthma - immunology; Asthma - prevention & control; Beclomethasone - therapeutic use; Biological and medical sciences; Double-Blind Method; eosinophils; Eosinophils - immunology; Female; Glucocorticoids - therapeutic use; Humans; Immunopathology; induced sputum; Leukocyte Count; Male; Medical sciences; Predictive Value of Tests; Recurrence; Respiratory and ent allergic diseases; Sputum - immunology
• ISSN: 0954-7894; 1365-2222
• DOI: 10.1046/j.1365-2222.2000.00919.x

To assess whether sputum eosinophilia predicts the recurrence of asthma symptoms after withdrawal of therapy in moderate stable asthmatics on low‐dose inhaled corticosteroids. Randomized, double‐blind, placebo‐controlled study involving 30 subjects with stable asthma, asymptomatic, with low PEF variability measured over two run‐in weeks, on treatment with low‐dose inhaled beclomethasone dipropionate (BDP, 250 µg b.i.d. in the last 3 months). At the end of the run‐in, all patients underwent a methacholine challenge test and sputum induction (T1). They then stopped therapy and received either placebo (20 subjects, study group) or BDP at the same dose as in the previous 3 months (10 subjects, control group). They continued to monitor PEF and symptom score for 3 months, or until asthma symptoms recurred (diurnal and nocturnal symptom score ≥2 on two consecutive days). At the end of the study (T2), i.e., either within 5 days from the beginning of asthma symptoms or after 3 months in subjects without recurrence of asthma symptoms, all subjects repeated the methacholine challenge test and sputum induction. In the placebo‐treated group, sputum eosinophils at T1 were significantly higher in subjects who subsequently developed recurrence of asthma symptoms (n = 7) after cessation of treatment than in subjects who remained asymptomatic for 3 months (8.2% [0–56.6] vs 0.9% [0–11], P