Joyce Thompson

Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma

Background: Cigarette smokers with asthma are insensitive to short term inhaled corticosteroid therapy, but efficacy when given for a longer duration at different doses is unknown. Methods: Ninety five individuals with mild asthma were recruited to a multicentre, randomised, double blind, parallel group study comparing inhaled beclomethasone in doses of 400 μg or 2000 μg daily for 12 weeks in smokers and non-smokers. The primary end point was the change in morning peak expiratory flow (PEF). Secondary end points included evening PEF, use of reliever inhaler, number of asthma exacerbations, spirometric parameters, and asthma control score. Results: After 12 weeks of inhaled beclomethasone there was a considerable difference between the morning PEF measurements of smokers and non-smokers with asthma (−18 (95% CI −35 to −1), adjusted p = 0.035). Among those receiving 400 μg daily there was a difference between the mean (95% CI) morning PEF (l/min) in smokers and non-smokers (−25 (95% CI −45 to −4), adjusted p = 0.019) and in the number of asthma exacerbations (6 v 1 in smokers and non-smokers, respectively, p = 0.007). These differences were reduced between smokers and non-smokers receiving 2000 μg inhaled beclomethasone daily. Conclusions: Compared with non-smokers, smokers with mild persistent asthma are insensitive to the therapeutic effect of low dose inhaled corticosteroid treatment administered for a 12 week period. The disparity of the response between smokers and non-smokers appears to be reduced with high dose inhaled corticosteroid. These findings have important implications for the management of individuals with mild asthma who smoke.

Effect of improved home ventilation on asthma control and house dust mite allergen levels

Background:  The warm, humid environment in modern homes favours the dust mite population, but the effect of improved home ventilation on asthma control has not been established. We tested the hypothesis that a domestic mechanical heat recovery ventilation system (MHRV), in addition to allergen avoidance measures, can improve asthma control by attenuating re‐colonization rates.

Effectiveness of bronchial thermoplasty in severe asthma in ‘real life’ patients compared with those recruited to clinical trials in the same centre:

Published information on the effectiveness of bronchial thermoplasty (BT) for severe asthma in ‘real life’ patients is limited. We compared safety and efficacy outcomes 12 months post procedure in 10 clinic patients and 15 patients recruited to clinical trials of BT at the same centre. Baseline asthma severity was greater in the clinic group. Adverse events were similar. Clinical improvements occurred in 50% of the clinic patients compared with 73% of the research patients.

Dust allergen and LPS concentrations and their effects on biomarkers of asthma in adults with house dust mite-sensitive asthma

2008 The Authors Journal Compilation 2008 Blackwell Publishing Ltd, Immunology, 125, Supplement 1, 1 144 Metchnikoff Centenary – Macrophages and Immunity IS2 Heterogeneity of mouse and human monocytesThis paper looks at the effects of dust allergen and LPS concentrations on biomarkers of asthma in adults with house dust mite-sensitive asthma.