Trial reportThorax1999
Effect of differing doses of inhaled budesonide on markers of airway inflammation in patients with mild asthma.
Trial report in Thorax, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Exhaled nitric oxide levels to guide treatment for children with asthma.The Cochrane database of systematic reviews · 2016Pooled it
- Initial starting dose of inhaled corticosteroids in adults with asthma: a systematic review.Thorax · 2004Pooled it
- Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: a comprehensive review.Respiratory research · 2004Pooled it
- High dose versus low dose inhaled corticosteroid as initial starting dose for asthma in adults and children.The Cochrane database of systematic reviews · 2004Pooled it
- Budesonide at different doses for chronic asthma.The Cochrane database of systematic reviews · 2001Pooled it
- Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: a cross-over randomised controlled trial.Respiratory research · 2018Trial
- A phase 1, randomized, placebo-controlled, dose-escalation study of an anti-IL-13 monoclonal antibody in healthy subjects and mild asthmatics.British journal of clinical pharmacology · 2013Trial
- Is low dose inhaled corticosteroid therapy as effective for inflammation and remodeling in asthma? A randomized, parallel group study.Respiratory research · 2012Trial
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- Induced sputum: current progress and prospect.European journal of medical research · 2025Review
- Impact of Anti-IL5 Therapies on Patients with Severe Uncontrolled Asthma and Possible Predictive Biomarkers of Response: A Real-Life Study.International journal of molecular sciences · 2023Observational
- Heart Rate Variability Biofeedback Does Not Substitute for Asthma Steroid Controller Medication.Applied psychophysiology and biofeedback · 2018Article
- Inhaled corticosteroids improve lung function, airway hyper-responsiveness and airway inflammation but not symptom control in patients with mild intermittent asthma: A meta-analysis.Experimental and therapeutic medicine · 2017Article
- Exhaled nitric oxide levels to guide treatment for adults with asthma.The Cochrane database of systematic reviews · 2016Review
- Detailed analysis of sputum and systemic inflammation in asthma phenotypes: are paucigranulocytic asthmatics really non-inflammatory?BMC pulmonary medicine · 2016Article
- Biomarkers in the Management of Difficult Asthma.Current topics in medicinal chemistry · 2016Review
- Regulatory Considerations for Approval of Generic Inhalation Drug Products in the US, EU, Brazil, China, and India.The AAPS journal · 2015Article
- Exhaled nitric oxide predicts persistence of wheezing, exacerbations, and decline in lung function in wheezy infants and toddlers.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2013Article
- Arginase and arginine dysregulation in asthma.Journal of allergy · 2011Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt is desirable to prescribe the minimal effective dose of inhaled steroids to control asthma. To ensure that inflammation is suppressed whilst using the lowest possible dose, a sensitive and specific method for assessing airway inflammation is needed.
methodsThe usefulness of exhaled nitric oxide (NO), sputum eosinophils, and methacholine airway responsiveness (PC20) for monitoring airway inflammatory changes following four weeks of treatment with an inhaled corticosteroid (budesonide via Turbohaler) were compared. Mild stable steroid naive asthmatic subjects were randomised into two double blind, placebo controlled studies. The first was a parallel group study involving three groups receiving either 100 micrograms/day budesonide (n = 8), 400 micrograms/day budesonide (n = 7), or a matched placebo (n = 6). The second was a crossover study involving 10 subjects randomised to receive 1600 micrograms budesonide or placebo. The groups were matched with respect to age, PC20, baseline FEV1 (% predicted), exhaled NO, and sputum eosinophilia.
resultsThere were significant improvements in FEV1 following 400 micrograms and 1600 micrograms budesonide (11.3% and 6.5%, respectively, p < 0.05). This was accompanied by significant reductions in eosinophil numbers in induced sputum (0.7 and 0.9 fold, p < 0.05). However, levels of exhaled NO were reduced following each budesonide dose while PC20 was improved only with 1600 micrograms budesonide. These results suggest that exhaled NO and PC20 may not reflect the control of airway inflammation as accurately as the number of eosinophils in sputum. There were dose dependent changes in exhaled NO, sputum eosinophils, and PC20 to inhaled budesonide but a plateau response of exhaled NO was found at a dose of 400 micrograms daily.
conclusionMonitoring the number of eosinophils in induced sputum may be the most accurate guide to establish the minimum dose of inhaled steroids needed to control inflammation. This, however, requires further studies involving a larger number of patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.