Inhaled and systemic corticosteroid response in severe asthma assessed by alveolar nitric oxide: a randomized crossover pilot study of add-on therapy.

British Journal of Clinical Pharmacology
Peter A WilliamsonBrian J Lipworth

Abstract

Alveolar nitric oxide (CA(NO)) is a potential biomarker of small airway inflammation. We investigated effects on CA(NO) of the addition of coarse and fine particle inhaled corticosteroids to standard therapy in severe asthma. Severe asthmatics taking ≥1600 µg day(-1) budesonide or equivalent performed a randomized open-label crossover study. Subjects with FEV(1) < 80%, gas trapping and CA(NO) ≥2 ppb entered a 6 week dose-ramp run-in of fluticasone/salmeterol(FPSM) 250/50 µg twice daily for 3 weeks, then 500/50 µg twice daily for 3 weeks. Patients then received additional HFA-beclomethasone diproprionate (BDP) 200 µg twice daily or FP 250 µg twice daily for 3 weeks in a crossover. Participants then received prednisolone(PRED) 25 mg day(-1) for 1 week. Nitric oxide, lung function, mannitol challenge, systemic inflammatory markers and urinary cortisol were measured. Fifteen completed per protocol: mean (SD) age 51 (12) years, FEV(1) 58 (13)% predicted, residual volume 193 (100)% predicted and mannitol(PD10) 177 (2.8) µg. There was no significant difference between FPSM and add-on therapy for CA(NO). FPSM/BDP and FPSM/PRED suppressed broncial flux (Jaw(NO)) and FE(NO) compared with FPSM alone, but there was no significant differenc...Continue Reading

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Citations

Mar 29, 2013·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Brian Lipworth
Jun 6, 2014·The Lancet. Respiratory Medicine·Brian LipworthWilliam Anderson
Sep 10, 2013·The Journal of Allergy and Clinical Immunology·Brian Lipworth
Dec 4, 2015·The Cochrane Database of Systematic Reviews·Djillali AnnaneYizhak Kupfer
Jun 21, 2018·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Zsófia LázárAndrás Bikov
Jun 27, 2019·Journal of Breath Research·Tuomas Karvonen, Lauri Lehtimäki
Jul 3, 2019·Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology·Chris RuiWen KuoBrian J Lipworth

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