Sputum Eosinophils and the response of exercise-induced Bronchoconstriction to corticosteroid in asthma
Sputum Eosinophils and the response of exercise-induced Bronchoconstriction to corticosteroid in asthma
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DOI：
10.1378/chest.07-2048
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发表时间：
2008-02-01
期刊：
影响因子：
9.6
通讯作者：
O'Byrne, Paid M.
中科院分区：
文献类型：
--
作者：
Duong, MyLinh;Subbarao, Padmaja;O'Byrne, Paid M.
背景资料：嗜酸性粒细胞性气道炎症和运动诱发的支气管收缩（EIB）之间的关系，并对吸入性皮质类固醇（ICS）therapy.Methods：26例激素初治哮喘患者EIB随机分为两个平行，双盲，交叉研究组（每组13例）。每组比较两种剂量水平的吸入性环索奈德，给药3周，洗脱期为3至8周，如下：（1）每天40 μ g vs 160 μ g;（2）每天80 μ g vs 320 μ g。基线和每周评估与运动的挑战和痰analysis.Results：数据汇总，并表明，10名受试者有基线痰嗜酸性粒细胞>= 5%。只有高剂量ICS治疗（即160和320 μ g）显着减弱痰嗜酸性粒细胞百分比。痰液嗜酸性粒细胞百分比与EIB严重程度显著相关，并预测EIB对高剂量治疗的程度和时间反应，但不能预测低剂量治疗（即40和80 μ g）。低剂量ICS治疗在1周时显著降低EIB，此后几乎没有额外的改善，与基线痰嗜酸性粒细胞计数无关。相反，与嗜酸性粒细胞计数<5%的受试者相比，高剂量ICS治疗对痰嗜酸性粒细胞增多的受试者EIB的改善显著更大。在EIB的改善幅度的嗜酸性粒细胞组之间的差异是明显的第一周后的高剂量ICS治疗，并增加了与time.Conclusions：这些结果表明，嗜酸性粒细胞气道炎症可能是重要的修改EIB的严重程度和ICS治疗的反应。因此，测量痰嗜酸性粒细胞百分比可能有助于预测EIB对不同剂量水平ICS的反应程度和时间。
Background: The relationship between eosinophilic airway inflammation and exercise-induced bronchoconstriction (EIB), and the response to inhaled corticosteroid (ICS) therapy was examined.Methods: Twenty-six steroid-naive asthmatic patients with EIB were randomized to two parallel, double-blind, crossover study arms (13 subjects in each arm). Each arm compared two dose levels of inhaled ciclesonide that were administered for 3 weeks with a washout period of 3 to 8 weeks, as follows: (1) 40 vs 160 mu g daily; and (2) 80 vs 320 mu g daily. Baseline and weekly assessments with exercise challenge and sputum analysis were performed.Results: Data were pooled and demonstrated that 10 subjects had baseline sputum eosinophilia >= 5%. Only high-dose ICS therapy (ie, 160 and 320 mu g) significantly attenuated the sputum eosinophil percentage. Sputum eosinophil percentage significantly correlated with EIB severity, and predicted the magnitude and temporal response of EIB to high-dose therapy, but not to low-dose therapy (ie, 40 and 80 jig). Low-dose ICS therapy provided a significant reduction in EIB at 1 week, with little additional improvement thereafter, irrespective of baseline sputum eosinophil counts. In contrast, high-dose ICS therapy provided a significantly greater improvement in EIB in subjects with sputum eosinophilia compared to those with an eosinophil count of < 5%. The difference between the eosinophilic groups in the magnitude of improvement in EIB was evident after the first week of high-dose ICS therapy and increased with time.Conclusions: These results suggest that eosinophilic airway inflammation may be important in modifying the severity of EIB and the response to ICS therapy. Measurements of sputum eosinophil percentage may, therefore, be useful in predicting the magnitude and temporal response of EIB to different dose levels of ICSs.