New Approach to Asthma Targets Sputum Eosinophils

Laurie Barclay, MD

December 02, 2002

Dec. 2, 2002 — A new approach to treating severe asthma, reported in the Nov. 30 issue of The Lancet, uses induced sputum to monitor eosinophils and to target their suppression. Although a controlled trial showed fewer exacerbations and hospitalizations in this group compared with the control group managed with standard guidelines, the authors suggest that this approach should only be used by specialists.

"Severe exacerbations of asthma needing courses of oral corticosteroids or hospital admission are the most serious manifestation of this disease," senior author Dr. Ian D. Pavord from Glenfield Hospital, Leicester, U.K., says in a news release. "They lead to asthma deaths, illness, and a high cost to the health service in terms of doctor consultations, drug use, and hospital beds."

In this randomized trial, 74 patients with moderate to severe asthma were managed for 12 months by British Thoracic Society (BTS) asthma guidelines or by normalization of the induced sputum eosinophil count. The latter group had inhaled or oral corticosteroids regulated in response to changes in sputum eosinophil concentration as the study progressed.

Compared with the BTS group, the sputum management group had a 63% reduction in sputum eosinophil count (95% confidence interval [CI], 24%-100%; P=.002), fewer severe asthma attacks (35 vs. 109; P=.01), and fewer hospitalizations (1 vs. 6; P=.047). Use of oral or inhaled corticosteroids was similar in both groups.

"Our results show that a strategy directed at maintenance of a normal airway eosinophilic count caused a large reduction in the number of severe exacerbations in a group of patients with moderate to severe asthma compared with traditional management based on the BTS guidelines," Dr. Pavord says. "We believe such an effect has implications for management of asthma in that it strongly supports the view that airway inflammation should be monitored regularly for the best treatment of this group of patients."

Lancet. 2002;360:1715-1721

Reviewed by Gary D. Vogin, MD

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