Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids

Aaron Deykin, Stephen C. Lazarus, John V. Fahy, Michael E. Wechsler, Homer A. Boushey, Vernon M. Chinchilli, Timothy J. Craig, Emily Dimango, Monica Kraft, Frank Leone, Robert F. Lemanske, Richard J. Martin, Gene R. Pesola, Stephen P. Peters, Christine A. Sorkness, Stanley J. Szefler, Elliot Israel

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143 Scopus citations

Abstract

Background: Although inhaled corticosteroids (ICSs) are effective in preventing deterioration in asthma control, at least half of subjects with mild-to-moderate asthma will remain stable when these agents are discontinued. Objective: We sought to determine whether noninvasive markers of inflammation predict which individuals maintain asthma control after discontinuation of ICSs. Methods: We analyzed data obtained from 164 subjects with mild-to-moderate asthma who participated in a 16-week trial comparing the effects of continued ICS use with the effects of a switch to salmeterol or placebo. Results: In comparison with continued ICS use, a switch to salmeterol or placebo was associated with increased rates of asthma deterioration over 16 weeks (9.3% vs 24.1% and 37.5%, respectively; P = .04 and P <. 001, respectively). We found that neither exhaled nitric oxide nor methacholine PC20, when measured at randomization or 2 weeks after randomization, were significant predictors of subsequent asthma control in subjects who discontinued ICSs. However, both induced sputum eosinophil counts measured 2 weeks after a switch from ICS to placebo and changes in sputum eosinophil counts from before cessation of ICSs to after a switch to placebo predicted subsequent asthma deterioration (area under the receiver-operating characteristic curve, 0.771 [P <. 001] and 0.825 [P <. 001], respectively). Conclusion: On the basis of a model treatment strategy, we estimate that allocating subjects to ICS therapy on the basis of changes in sputum eosinophil counts after a trial discontinuation could allow 48% of subjects with mild-to-moderate asthma to discontinue ICS therapy without an increased risk of asthma deterioration over a period of at least 14 weeks.

Original languageEnglish (US)
Pages (from-to)720-727
Number of pages8
JournalJournal of Allergy and Clinical Immunology
Volume115
Issue number4
DOIs
StatePublished - Apr 2005
Externally publishedYes

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Keywords

  • Asthma
  • Eosinophils
  • Exacerbation
  • Inhaled corticosteroids
  • Methacholine
  • Nitric oxide
  • Sputum

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Deykin, A., Lazarus, S. C., Fahy, J. V., Wechsler, M. E., Boushey, H. A., Chinchilli, V. M., Craig, T. J., Dimango, E., Kraft, M., Leone, F., Lemanske, R. F., Martin, R. J., Pesola, G. R., Peters, S. P., Sorkness, C. A., Szefler, S. J., & Israel, E. (2005). Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. Journal of Allergy and Clinical Immunology, 115(4), 720-727. https://doi.org/10.1016/j.jaci.2004.12.1129