Airway inflammation in patients with symptoms suggesting asthma but with normal lung function

The hypothesis that eosinophilic airway inflammation is present in many pat ients presenting with respiratory symptoms suggestive of asthma but with no rmal lung function was tested. Thirty-six consecutive patients presenting with these features were studied . Twenty-five asthmatics and 43 healthy volunteers served as control groups . Signs of eosinophilic inflammation in blood and induced sputum were studi ed. Patients with respiratory symptoms were single-blindly treated with inh aled beclomethasone dipropionate (BDP), 800 mug daily, or placebo for 3 mon ths, and re-examined at 3 months and 1 yr. Patients with respiratory symptoms had higher numbers of blood and sputum e osinophils than healthy persons (p<0.0001), but the degree of eosinophilic inflammation was less pronounced than in asthmatics (p<0.01). Three-month's treatment with BDP significantly reduced total symptom score (p<0.001), to ugh score (p<0.0001), and the number of blood eosinophils (p<0.01). For cou gh alone, the improvement was significant compared with placebo (p<0.05). T he patients were followed-up for 1 yr, and 17 (55%) still had symptoms but retained normal lung function. Four (13%) patients had developed asthma and another 10 (32%) had become free of symptoms. Using lung function measurements and induced sputum analyses, a group of pa tients with symptoms suggestive of asthma and signs of eosinophilic airway inflammation but without enough airflow variability to be diagnosed as asth matics were detected. They seemed to respond favourably to inhaled beclomet hasone dipropionate treatment.