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Systemic Inflammation and Its Response to Treatment in Patients With Asthma

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BACKGROUND: Asthma is an obstructive airway disease characterized by airway inflammation. OBJECTIVE: To measure systemic inflammation in asthma patients, and to assess the effect of treatment on systemic inflammation. METHODS: In 30 newly diagnosed non-randomized adult asthma patients we measured systemic inflammation markers (serum high-sensitivity C-reactive protein, total leukocyte count, and erythrocyte sedimentation rate) before and after a 6-week standard treatment with inhaled steroids and inhaled β2 agonist. The comparison group comprised 20 healthy control subjects. All the subjects were non-smokers. RESULTS: The measured systemic inflammation markers were higher in the asthma patients: high-sensitivity C-reactive protein 4.8 ± 6.0 mg/dL vs 1.5 ± 1.4 mg/dL, P < .001; total leukocyte count 8,936 ± 2,592 cells/μL versus 7,741 ± 1,924 cells/μL, P < .001; erythrocyte sedimentation rate 24.8 ± 12.3 mm/h versus 15.3 ± 6.5 mm/h, P < .001. In the asthma patients, high-sensitivity C-reactive protein negatively correlated with percent-of-predicted FEV1 (r = −0.64, P = .001), percent-of-predicted forced vital capacity (FVC) (r = −0.39, P = .03), FEV1/FVC% (r = −0.71, P < .001), and percent-of-predicted forced expiratory flow during the middle half of the FVC maneuver (FEF25-75) (r = −0.51, P = .004). Total leukocyte count negatively correlated with percent-of-predicted FEV1 (r = −0.64, P = .001), percent-of-predicted FEV1/FVC (r = −0.74, P < .001), and percent-of-predicted FEF25-75 (r = −0.58, P = .001). Body mass index positively correlated with high-sensitivity C-reactive protein (r = 0.65, P < .001). Multiple linear regression showed significant correlation of high-sensitivity C-reactive protein (r2 = 0.75) with age (β = 0.31, P = .008), body mass index (β = 0.99, P = .001), family size (β = 0.33, P = .008), and weight (β = ‐0.45, P = .01). The systemic inflammation markers decreased significantly (P < .001 for all comparisons) after 6 weeks of treatment: high-sensitivity C-reactive protein decreased from 4.8 ± 6.0 mg/dL to 2.4 ± 5.4 mg/dL, total leukocyte count decreased from 8,936 ± 2,592 cells/μL to 6,960 ± 1,785 cells/μL, and erythrocyte sedimentation rate decreased from 24.8 ± 12.3 mm/h to 15.8 ± 10.1 mm/h. CONCLUSIONS: Inhaled steroids plus inhaled β2 agonist significantly reduced systemic inflammation in asthma patients.

Keywords: acute phase reactants; asthma; high-sensitivity C-reactive protein; inhaled corticosteroids; systemic inflammation

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00601

Affiliations: Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA

Publication date: June 1, 2011

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