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Seventy four subjects with moderate to severe asthma were randomised to either standard management according to BTS guidelines or to “sputum management” where patients were given escalating doses of corticosteroids and leukotriene antagonists in order to bring the eosinophil counts in their induced sputum to the target level of 1–3% or their exhaled NO level to <8 ppb. There were 109 exacerbations in the BTS management group compared with 35 in the sputum management group (p=0.01), and significantly fewer courses of oral steroids (p=0.008) and admissions (p=0.047) were required in the latter group over 1 year. It is possible that treatment for asthma targeted at controlling airway inflammatory markers, particularly sputum eosinophils, might be more effective at reducing exacerbations than treatment based on traditional assessments of symptoms, peak flow, and the use of inhaled β2 agonists.
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