An inhaled steroid improves markers of airway inflammation in patients with mild asthma

Airway inflammation can be demonstrated in mildly asthmatic patients who ar e not treated with inhaled steroids. Current guidelines recommend that inha led steroids should be introduced in mild asthmatics who use an inhaled bet a(2)-agonist more than once daily, It was postulated that inhaled steroids can have antiinflammatory effects in patients with even milder disease. The effect of 4 weeks of treatment with budesonide (800 mu g twice daily by Turbohaler(R)) was studied in 10 steroid-naive mildly asthmatic patients ( forced expiratory volume in one second (FEV1) = 96+/-1.4% predicted) who re quired an inhaled beta(2)-agonist less than one puff daily, in a double-bli nd, placebo-controlled, crossover fashion, Spirometry, exhaled nitric oxide (NO), bronchial responsiveness (provocative concentration causing a 20% Fa ll in FEV1 (PC20)), and sputum induction were performed before and after ea ch treatment period, Following budesonide treatment, there were significant improvements in FEV1 , and PC20, in association with a significant reduction in the percentage o f eosinophils in induced sputum. Exhaled NO levels tended towards reduction , but the change was nonsignificant. There were also nonsignificant reducti ons in sputum eosinophil cationic protein and tumour necrosis factor-alpha levels. In conclusion inhaled budesonide can lead to improvements in noninvasive ma rkers of airway inflammation, in association with a small improvement in lu ng function, even in mildly asthmatic patients who require an inhaled beta( 2)-agonist less than once daily. This suggests a potential benefit of inhal ed corticosteroids, even in relatively asymptomatic asthma.