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

Research output: Contribution to journalArticle

141 Citations (Scopus)

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

Fingerprint

Sputum
Eosinophils
Adrenal Cortex Hormones
Asthma
Placebos
Random Allocation
Methacholine Chloride
ROC Curve
Nitric Oxide
Therapeutics
Inflammation

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Deykin, Aaron ; Lazarus, Stephen C. ; Fahy, John V. ; Wechsler, Michael E. ; Boushey, Homer A. ; Chinchilli, Vernon M. ; Craig, Timothy J. ; Dimango, Emily ; Kraft, Monica ; Leone, Frank ; Lemanske, Robert F. ; Martin, Richard J. ; Pesola, Gene R. ; Peters, Stephen P. ; Sorkness, Christine A. ; Szefler, Stanley J. ; Israel, Elliot. / Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. In: Journal of Allergy and Clinical Immunology. 2005 ; Vol. 115, No. 4. pp. 720-727.
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title = "Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids",
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.",
author = "Aaron Deykin and Lazarus, {Stephen C.} and Fahy, {John V.} and Wechsler, {Michael E.} and Boushey, {Homer A.} and Chinchilli, {Vernon M.} and Craig, {Timothy J.} and Emily Dimango and Monica Kraft and Frank Leone and Lemanske, {Robert F.} and Martin, {Richard J.} and Pesola, {Gene R.} and Peters, {Stephen P.} and Sorkness, {Christine A.} and Szefler, {Stanley J.} and Elliot Israel",
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Deykin, A, Lazarus, SC, Fahy, JV, Wechsler, ME, Boushey, HA, Chinchilli, VM, Craig, TJ, Dimango, E, Kraft, M, Leone, F, Lemanske, RF, Martin, RJ, Pesola, GR, Peters, SP, Sorkness, CA, Szefler, SJ & Israel, E 2005, 'Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids', Journal of Allergy and Clinical Immunology, vol. 115, no. 4, pp. 720-727. https://doi.org/10.1016/j.jaci.2004.12.1129

Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. / Deykin, Aaron; Lazarus, Stephen C.; Fahy, John V.; Wechsler, Michael E.; Boushey, Homer A.; Chinchilli, Vernon M.; Craig, Timothy J.; Dimango, Emily; Kraft, Monica; Leone, Frank; Lemanske, Robert F.; Martin, Richard J.; Pesola, Gene R.; Peters, Stephen P.; Sorkness, Christine A.; Szefler, Stanley J.; Israel, Elliot.

In: Journal of Allergy and Clinical Immunology, Vol. 115, No. 4, 04.2005, p. 720-727.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids

AU - Deykin, Aaron

AU - Lazarus, Stephen C.

AU - Fahy, John V.

AU - Wechsler, Michael E.

AU - Boushey, Homer A.

AU - Chinchilli, Vernon M.

AU - Craig, Timothy J.

AU - Dimango, Emily

AU - Kraft, Monica

AU - Leone, Frank

AU - Lemanske, Robert F.

AU - Martin, Richard J.

AU - Pesola, Gene R.

AU - Peters, Stephen P.

AU - Sorkness, Christine A.

AU - Szefler, Stanley J.

AU - Israel, Elliot

PY - 2005/4

Y1 - 2005/4

N2 - 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.

AB - 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.

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DO - 10.1016/j.jaci.2004.12.1129

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JF - Journal of Allergy and Clinical Immunology

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