Chest
Original ResearchAsthmaDifferences in Airway Cytokine Profile in Severe Asthma Compared to Moderate Asthma
Section snippets
Study Subjects
Physicians at two tertiary care centers were asked to identify patients with severe asthma who met the following criteria proposed by the ATS workshop on refractory asthma.10 For severe asthma, subjects were required to have received treatment with daily oral steroids for > 50% of the previous 12 months or to have been prescribed high-dose inhaled-steroid equivalent to > 880 μg/d of fluticasone, (ex-actuator) with at least one other add-on therapy (long acting β-agonist, leukotriene receptor
Clinical Characteristics
Characteristics of the 26 subjects with severe asthma and 24 subjects with moderate or treatment responsive asthma are provided in Table 1 . Subjects were of similar age, and there was a trend toward a higher proportion of women in the severe group. Four subjects in each group had smoked > 10 pack-years, and a similar proportion was obese as judged by a body mass index (BMI) ≥ 30 kg/m2. Among those in whom the age of onset could be determined, 18 of 21 subjects in the moderate group and 20 of
Discussion
We studied subjects with severe poorly controlled asthma, compliant with medication, and compared them to patients whose disease was moderate and managed successfully with regular inhaled steroids in conjunction with long-acting β-agonists in many instances. Despite high doses of inhaled or supplemental doses of oral corticosteroids, the patients with severe asthma had more airway inflammation as reflected in sputum eosinophilia and neutrophilia. Furthermore, these subjects expressed a
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Dr. Ernst and Dr. Martin have received an unrestricted grant from GlaxoSmithKline that was in part used to support this project.
None of the other authors have any conflicts of interest to declare.
This study and the Difficult Asthma Program are supported by the Richard and Edith Strauss Canada Foundation and an unrestricted grant from GlaxoSmithKline, Canada. Joanne Shannon was the recipient of the Ann Woolcock Memorial Fellowship financed by GlaxoSmithKline, Canada.