THE USE OF SERUM EOSINOPHIL CATIONIC PROTEIN (ECP) IN THE MANAGEMENT OF STEROID-THERAPY IN CHRONIC ASTHMA

Background Corticosteroid therapy has become the mainstay in the treat ment of asthma. However, the risk-benefit balance in the patient calls for assessment of the state of inflammation in the airways. In this r espect serum eosinophil cationic protein (ECP) might be a marker, whic h can easily be measured in a clinical setting. Studies have indicated a relation between level of serum ECP and activity and severity in as thma. Objective To investigate the feasibility to guide steroid therap y on the basis of the level of serum ECP in patients with chronic asth ma. Methods Twenty adult patients on maintenance inhaled steroid thera py visited the chest clinic once every 2 months over a 12-month period . At each visit a short history, blood sample for ECP and number of eo sinophils, baseline spirometry, and histamine inhalation provocation t est (PC20) were obtained. On the basis of level of ECP, adjustments in daily dose of steroids were considered. Data were compared with those of a previous 6-month ECP evaluation study in these same patients. Re sults In 10 patients mean dose of inhaled steroids was decreased great er than or equal to 25%. ECP rose slightly (antilogged mean from 9.06 to 11.8 mu g/L) and lung function decreased slightly (mean FEV1 %predi cted from 85.5 to 81.6). In seven patients mean dose of inhaled or ora l (n = 2) steroids was increased greater than or equal to 25%. In this group ECP decreased but remained elevated at greater than or equal to 20 mu g/L (antilogged mean from 30.5 to 25.6 mu g/L) and lung functio n improved (mean FEV1 %predicted from 67.2 to 74.5). In both groups pa tients' scores of asthmatic well-being increased significantly, and PC 20 did not show a trend. Exacerbation rate remained the same in the de creased and the no change group (n = 3, in which no substantial change in steroid dose occurred), but was reduced by about 50% in the increa sed group. Conclusion From this observational study it is concluded th at adjusting steroid therapy guided by serum ECP-level may be helpful in tailoring asthma treatment.