EOSINOPHIL AND NEUTROPHIL ACTIVITY IN ASTHMA IN A ONE-YEAR TRIAL WITHINHALED BUDESONIDE - THE IMPACT OF SMOKING

The object of this investigation was to study the long-term effects of antiasthma treatment on blood markers of inflammation and lung functi on in adult asthmatic subjects. For this purpose 85 allergic and nonal lergic asthmatic subjects were randomized into three groups, which wer e given high-dose; (1,600 mu g/d) inhaled budesonide, low-dose (400 mu g/d) inhaled budesonide, and oral theophylline (600 mg/d), respective ly, and were followed for 11 mo with testing of lung function and bloo d sampling for the assay in serum of eosinophil cationic protein (ECP) , eosinophil protein x/eosinophil derived neurotoxin (EPX/EDN) as eosi nophil markers, and myeloperoxidase (MPO) and lactoferrin (LF) as neut rophil markers. Lung functions (FEV(1)% predicted, and histamine PC20) and the eosinophil markers ECP and EPX/EDN were improved and reduced, respectively, by budesonide in a dose-dependent and temporally parall el fashion. Theophylline did not alter lung functions but reduced ECP and EPX/EDN after prolonged treatment. The treatment efficacy of budes onide was attributed solely to an effect on nonsmoking asthmatic subje cts, since neither lung functions nor eosinophil markers changed in sm okers even with high-dose budesonide. MPO but not LF was reduced after several months of treatment in all three groups, but only in nonsmoke rs. We conclude that ECP and EPX/EDN may be used to monitor antiinflam matory treatment in asthmatic patients, and that smoking asthmatic sub jects are resistant to inhaled corticosteroids.