Thorax 2000;55:232-234 ( March )

Short paper

Non-invasive markers of airway inflammation as predictors of oral steroid responsiveness in asthma Stuart A Little^a, George W Chalmers^a, Kirsten J MacLeod^b, Charles McSharry^b, Neil C Thomson^a

^a Department of Respiratory Medicine, Western Infirmary, Glasgow G11 6NT, UK, ^b Department of Immunology

Correspondence to: Dr S A Little

Received 8 March 1999; Returned to authors 22 September 1999; Revised version received 8 November 1999; Accepted for publication 25 November 1999

BACKGROUNDSputum eosinophil counts and exhaled nitric oxide (NO) levels are increased in asthma and both measurements fall in response to corticosteroids.
METHODSExhaled NO levels and sputum eosinophil counts were assessed as non-invasive markers of the response to an oral steroid in 37 patients (19 women) with stable chronic asthma (mean (SD) age 48.6 (12.2) years, asthma duration 25.9 (17.3) years, and baseline forced expiratory volume in one second (FEV₁) 76.3 (21.9)% predicted). Spirometric tests, with reversibility to a  agonist (2.5 mg nebulised salbutamol), and induced sputum (using nebulised 3% saline) were performed at recruitment and following treatment with 30 mg prednisolone/day for 14 days.
RESULTSBaseline NO levels correlated with the percentage improvement in FEV₁ from baseline to the post-steroid, post-bronchodilator value (r_s = 0.47, p = 0.003), with an NO level of >10 ppb at baseline having a positive predictive value of 83% for an improvement in FEV₁ of 15% (sensitivity 59%, specificity 90%). Sputum eosinophilia (4%) had a positive predictive value of 68% (sensitivity 54%, specificity 76%) for an increase in FEV₁ of 15%. A combination of sputum eosinophilia and increased NO levels resulted in a positive predictive value of 72% and a negative predictive value of 79% (sensitivity 76%, specificity 75%).
CONCLUSIONExhaled NO levels and sputum eosinophilia may be useful in predicting the response to a trial of oral steroid in asthma.


Keywords: airway inflammation; nitric oxide; induced sputum eosinophilia; asthma; corticosteroids

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© 2000 by Thorax
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