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Published on: November 4, 2010
Clinically masked increases in bronchial inflammation in guideline-treated persistent asthma
Julia G Koopmans1, René Lutter, Henk M Jansen
1Department of Pulmonology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Pulmonary Pharmacology & Therapeutics
|November 22, 2005
Summary
Allergen exposure can cause hidden airway inflammation in persistent asthma patients, even when symptoms are controlled by guidelines. This suggests current treatment adjustments may need further guidance beyond symptom monitoring.
Area of Science:
- Allergy and Immunology
- Pulmonology
- Pharmacology
Background:
- Current persistent asthma management typically combines inhaled corticosteroids and Beta2-agonists.
- Treatment adjustments are primarily based on symptom presence.
Purpose of the Study:
- To determine if allergen exposure triggers subclinical airway inflammation in persistent asthma patients adhering to guidelines.
- To assess if current guideline-based therapy masks underlying inflammatory responses.
Main Methods:
- 48 allergic persistent asthma patients underwent a 4-week fluticasone run-in.
- Bronchial challenge with allergen was performed after salbutamol inhalation.
- FEV1 and sputum eosinophils were measured pre- and post-challenge; rescue salbutamol use was recorded.
Main Results:
- A significant increase in sputum eosinophils was observed post-allergen challenge (p=0.01).
- No significant changes in FEV1 were detected between 4-8 hours post-challenge (p>0.9).
- No patients required additional rescue salbutamol within 8 hours.
Conclusions:
- Clinically silent increases in bronchial inflammation occur in persistent asthma after allergen exposure, despite guideline-based treatment.
- This highlights a need for improved methods to guide anti-inflammatory therapy adjustments in persistent asthma.
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