{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T13:40:29Z","timestamp":1697463629515},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2007,6,15]],"date-time":"2007-06-15T00:00:00Z","timestamp":1181865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2007,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Background\n\t\t\t\t\t<\/jats:bold> Back\u2010titration of inhaled corticosteroid (ICS) dose in well\u2010controlled asthma patients is emphasized in clinical guidelines, but there are few published data on the airway cell and cytokine changes in relation to ICS reduction. In our study, 20 mild\u2010to\u2010moderate persistent (inspite of low\u2010moderate dose ICS treatment) asthmatic subjects prospectively rendered largely asymptomatic by high\u2010dose ICS were assessed again by clinical, physiological, and airway inflammatory indices after 4\u20138 weeks of reduced ICS treatment. We aimed at assessing the underlying pathological changes in relation to clinical deterioration.<\/jats:p><jats:p><jats:bold>Methods\n\t\t\t\t\t<\/jats:bold> Patients recorded daily symptom scores and peak expiratory flows (PEF). Spirometry and airways hyperreactivity (AHR) were measured and bronchoscopy was performed with assessment of airway biopsies (mast cells, eosinophils, neutrophils, and T lymphoctyes), bronchoalveolar lavage (BAL) IL\u20105 and eotaxin levels and cellular profiles at the end of high\u2010dose ICS therapy and again after ICS dose reduction. Baseline data were compared with symptomatic steroid\u2010free asthmatics (<jats:italic>n<\/jats:italic>=42) and non\u2010asthmatic controls (<jats:italic>n<\/jats:italic>=28).<\/jats:p><jats:p><jats:bold>Results\n\t\t\t\t\t<\/jats:bold> After ICS reduction, subjects experienced a variable but overall significant increase in symptoms and reductions in PEF and forced expiratory volume in 1\u2003s. There were no corresponding changes in AHR or airways eosinophilia. The most relevant pathogenic changes were increased CD4<jats:sup>+<\/jats:sup>\/CD8<jats:sup>+<\/jats:sup> T cell ratio, and decreased sICAM\u20101 and CD18 macrophage staining (potentially indicating ligand binding). However, there was no relationship between the spectrum of clinical deterioration and the changes in cellular profiles or BAL cytokines.<\/jats:p><jats:p><jats:bold>Conclusions\n\t\t\t\t\t<\/jats:bold> These data suggest that clinical markers remain the most sensitive measures of early deterioration in asthma during back\u2010titration of ICS, occurring at a time when AHR and conventional indices of asthmatic airway inflammation appear unchanged. These findings have major relevance to management and to how back\u2010titration of ICS therapy is monitored.<\/jats:p>","DOI":"10.1111\/j.1365-2222.2007.02762.x","type":"journal-article","created":{"date-parts":[[2007,6,16]],"date-time":"2007-06-16T13:31:25Z","timestamp":1182000685000},"page":"1189-1198","source":"Crossref","is-referenced-by-count":6,"title":["Airway cell and cytokine changes in early asthma deterioration after inhaled corticosteroid reduction"],"prefix":"10.1111","volume":"37","author":[{"given":"Y. H.","family":"Khor","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B. N.","family":"Feltis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. W.","family":"Reid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Ward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. P.","family":"Johns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Wood\u2010Baker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. 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