“Refractory” Eosinophilic Airway Inflammation in Severe Asthma

Abstract

It has been suggested that patients with refractory eosinophilic airway inflammation represent a separate “eosinophilic” asthma phenotype associated with increased morbidity and a poor prognosis. To investigate whether persistent eosinophilia in these patients is a fixed feature or can still be modified by treatment, we investigated the effect of high-dose intramuscular corticosteroids on eosinophils in induced sputum. Twenty-two patients with stable severe asthma (15 women, aged 21–73 years) participated in this double-blind, placebo-controlled study. All were using inhaled corticosteroids (⩾ 1,600 μg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (⩾ 2%). Two weeks after treatment with triamcinolone, but not placebo, sputum eosinophils almost completely disappeared from a median of 12.6–0.2% (p < 0.001). In 82% of patients, no eosinophils could be observed at all. In addition, the rescue medication score decreased...