Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids

J Allergy Clin Immunol. 2005 Apr;115(4):720-7. doi: 10.1016/j.jaci.2004.12.1129.


Background: Although inhaled corticosteroids (ICSs) are effective in preventing deterioration in asthma control, at least half of subjects with mild-to-moderate asthma will remain stable when these agents are discontinued.

Objective: We sought to determine whether noninvasive markers of inflammation predict which individuals maintain asthma control after discontinuation of ICSs.

Methods: We analyzed data obtained from 164 subjects with mild-to-moderate asthma who participated in a 16-week trial comparing the effects of continued ICS use with the effects of a switch to salmeterol or placebo.

Results: In comparison with continued ICS use, a switch to salmeterol or placebo was associated with increased rates of asthma deterioration over 16 weeks (9.3% vs 24.1% and 37.5%, respectively; P = .04 and P < .001, respectively). We found that neither exhaled nitric oxide nor methacholine PC 20 , when measured at randomization or 2 weeks after randomization, were significant predictors of subsequent asthma control in subjects who discontinued ICSs. However, both induced sputum eosinophil counts measured 2 weeks after a switch from ICS to placebo and changes in sputum eosinophil counts from before cessation of ICSs to after a switch to placebo predicted subsequent asthma deterioration (area under the receiver-operating characteristic curve, 0.771 [ P < .001] and 0.825 [ P < .001], respectively).

Conclusion: On the basis of a model treatment strategy, we estimate that allocating subjects to ICS therapy on the basis of changes in sputum eosinophil counts after a trial discontinuation could allow 48% of subjects with mild-to-moderate asthma to discontinue ICS therapy without an increased risk of asthma deterioration over a period of at least 14 weeks.

Publication types

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

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives*
  • Asthma / drug therapy*
  • Asthma / immunology
  • Asthma / physiopathology
  • Biomarkers / analysis*
  • Bronchodilator Agents / administration & dosage
  • Cell Count
  • Eosinophils / cytology
  • Eosinophils / drug effects*
  • Female
  • Humans
  • Male
  • Nitric Oxide / metabolism
  • ROC Curve
  • Respiratory Function Tests
  • Retrospective Studies
  • Salmeterol Xinafoate
  • Sputum / cytology*


  • Adrenal Cortex Hormones
  • Biomarkers
  • Bronchodilator Agents
  • Nitric Oxide
  • Salmeterol Xinafoate
  • Albuterol