Abstract
IntroductionThe fraction of exhaled nitric oxide (FeNO) and blood eosinophils, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known concerning the relationship between the FeNO levels and blood eosinophils in asthmatics.MethodsTwenty severe asthmatics with persistent FeNO elevation (≥40 ppb) and blood eosinophilia (≥3%) despite maintenance therapy including high‐daily‐dose inhaled corticosteroids were analyzed. We investigated the response of FeNO and blood eosinophils to systemic corticosteroids treatment and the change in Asthma Control Questionnaire (ACQ) according to differences in the response of FeNO and blood eosinophils to steroid.ResultsThe changes in blood eosinophils were not correlated with the changes in FeNO levels by systemic steroid treatment (r = 0.37, P = 0.11). 50% of the subjects showed both ≥20% reductions in FeNO levels and blood eosinophils. There were significant differences in the ACQ score between the steroid response group and poor response group (P < 0.005). The group in which both FeNO and blood eosinophils were suppressed fulfilled the change in score of ≥0.5 on the ACQ.ConclusionsIn the patients with severe asthma, responses to systemic corticosteroids were variable in terms of FeNO and blood eosinophils. It was necessary to suppress both persistent eosinophilia and high FeNO for the improvement of asthma control.
Highlights
The fraction of exhaled nitric oxide (FeNO) and blood eosinophils, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients
Twenty asthmatics were with persistent FENO elevation (40 ppb) and blood eosinophilia (3%) even after treatment with systemic steroid
IL-5 is responsible for eosinophilic inflammation and it is a specific and strong stimulus for eosinophil differentiation [7]
Summary
The fraction of exhaled nitric oxide (FeNO) and blood eosinophils, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known concerning the relationship between the FeNO levels and blood eosinophils in asthmatics. Results: The changes in blood eosinophils were not correlated with the changes in FeNO levels by systemic steroid treatment (r 1⁄4 0.37, P 1⁄4 0.11). Conclusions: In the patients with severe asthma, responses to systemic corticosteroids were variable in terms of FeNO and blood eosinophils. Fractional exhaled nitric oxide (FeNO) and blood eosinophils have been used to distinguish patients with high T helper 2 (Type-2) inflammation and to predict the therapeutic response to treatments targeting Type-2 associated cytokines [1]. Several previous studies have shown distinct associations between the FeNO levels or blood eosinophils and the clinical outcomes in terms of lung function, asthma control, and exacerbations [3, 4]. Little is known about the relationships between the FeNO levels and blood eosinophils in asthmatics
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