"Refractory" eosinophilic airway inflammation in severe asthma: effect of parenteral corticosteroids

Am J Respir Crit Care Med. 2004 Sep 15;170(6):601-5. doi: 10.1164/rccm.200404-440OC. Epub 2004 Jun 23.


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 (> or = 1,600 microg/day) or chronic oral prednisone. They were included if the percentage of eosinophils in induced sputum was above the upper limit of normal (> or = 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 from 1.4 to 0.8 (p = 0.01), and FEV1 improved from a median of 73.8-88.3% predicted (p = 0.001). We conclude that persistent sputum eosinophilia despite extensive antiasthma treatment is not a refractory phenomenon but is still sensitive to high-dose systemic corticosteroids. This implies that these patients with severe asthma need additional or alternative antiinflammatory treatment to combat the eosinophilia and associated poor prognosis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Aged
  • Anti-Inflammatory Agents / administration & dosage*
  • Asthma / drug therapy*
  • Asthma / immunology
  • Breath Tests
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Eosinophilia / immunology*
  • Female
  • Humans
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Nitric Oxide / analysis
  • Respiratory Function Tests
  • Severity of Illness Index
  • Sputum / immunology
  • Treatment Outcome
  • Triamcinolone / administration & dosage*


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Triamcinolone
  • Nitric Oxide