A comparison of the effects of nedocromil sodium and beclomethasone dipropionate on pulmonary function, symptoms, and bronchial responsiveness in patients with asthma

The efficacy of nedocromil sodium (NED) (4 mg twice daily) and beclomethasone dipropionate (BDP) (200 micrograms twice daily) in controlling the symptoms of asthma, the pulmonary function, and bronchial responsiveness to histamine was assessed in a double-blind, double-dummy, crossover study of 39 adult patients with chronic asthma. The patients, most of whom were assessed to be affected to a moderate degree, were insufficiently controlled in their current regimen of inhaled and/or oral bronchodilators. A 2-week baseline period preceded 6 weeks of treatment with each of the study drugs. Both treatment groups demonstrated improvements from baseline in clinical assessment of lung function performed after the first 6 weeks of treatment. No significant differences were observed when the effects of the treatments were compared on FEV1, FVC, and peak expiratory flow. Bronchial reactivity to histamine, measured as the amount of histamine causing a 20% fall in FEV1 (PC20), decreased significantly (p less than 0.05) after 6 weeks of treatment with BDP compared to the effect of NED treatment. Asthma severity, symptom score, and inhaled bronchodilator use demonstrated significantly better results with BDP. After crossover of treatment, the group transferring from NED to BDP continued to improve, whereas the group crossing from BDP to NED tended to demonstrate a major deterioration during the first 3 weeks, after which a stabilization or an increase in FEV1, FVC, and ln PC20 appeared to occur. It is concluded that NED for inhalation is a potent new drug for treatment of both atopic and nonatopic subjects with asthma. With the number of patients and dosages used, the effect on the pulmonary function was not significantly different from that of BDP after the initial 6 weeks of treatment, but BDP had a better effect on asthma severity, overall opinions, symptom score, bronchodilator use, ln PC20, and morning peak expiratory flow.     

Pranlukast allows reduction of inhaled steroid dose without deterioration in lung function in adult asthmatics]

We undertook a community based case-control study to measure the effect of pranlukast on the reduction of inhaled steroid in adult asthmatics. Forty-one adults completed a run-in period of 4 weeks on 800 microgram of beclomethasone dipropionate (BDP) documenting twice daily peak expiratory flow (PEF) and symptom score and therapeutic score on a standard diary. Forced expiratory volume in one second (FEV1.0), V50, V25 was measured once during the run-in period. Patients were then randomized to receive either pranlukast with 400 microgram of BDP or 400 microgram alone for 8 weeks. There was no difference in the symptom score and therapeutic between the two groups at any time point. However, morning and evening % PEF run-in expressed as a % of the PEF average during the run-in period was significantly lower at 8 weeks in the groups without pranlukast. There were subjects in the group without pranlukast (35.3%) compared to those with (20.8%) who had a 10% or more reduction in % PEF from the run-in period. The patients with an FEV1.0 < 80% predicted who were randomized to the control group were more likely (5 of 7) to have a fall in % PEF run-in and those randomized to received pranlukast were less likely to have a fall in % PEF run-in though this was not significant (2 of 6). In this study, pranlukast has demonstrated steroid sparing effect. Severe asthmatics (FEV1.0 < 80%) who deteriorate after reduction of inhaled steroid may benefit most from pranlukast. Larger studies are now required to explore this important effect.     

Long-term comparison of three combinations of albuterol, theophylline, and beclomethasone in children with chronic asthma.

Three combination regimens, (1) inhaled albuterol (ALB) with oral theophylline (THEO), (2) inhaled ALB with inhaled beclomethasone dipropionate (BDP), or (3) inhaled ALB, inhaled BDP, and oral THEO, were evaluated and compared as optimal pharmacotherapy for chronic asthma in 111 children. In this double-blind, parallel-group, multicenter study, children, aged 6 to 16 years with moderately severe asthma (unstable despite daily medications), were treated with one of the combinations for 12 weeks. Patients were evaluated every 4 weeks by spirometry and serum THEO measurement. Patients kept daily symptom diaries, measured peak flow rates twice daily, and recorded adverse events. Treatment groups did not differ in disease or demographic characteristics at study entry. All three combination treatments provided and maintained significant improvement in FVC, FEV1, and FEF25%-75% volume points, and compared with that of pretreatment, with no significant differences between treatments. Throughout the 12-week treatment period, however, patients receiving BDP had lower symptom scores, fewer had more than one asthma attack, fewer required "bursts" of prednisone (p = 0.001), and fewer required rescue medication (p = 0.009). Significantly more patients receiving BDP said that they felt better than they did at the beginning of the study compared with the number of patients not receiving BDP (p = 0.002). Adverse events were similar among treatment groups.     

Pulmonary function tests and airway responsiveness to methacholine in chronic bronchiectasis of the adult

Fifty adults with chronic bronchiectasis (mean duration since diagnosis: 25 +/- 16.4 years), excluding those cases secondary to tuberculosis or hypogammaglobulinemia, were investigated by a questionnaire, a chest radiograph and lung function tests. Of these, 29 with an FEV1 greater than 1.5 1 underwent methacholine inhalation tests. Fourty-three subjects and three subjects respectively showed an obstructive or a mixed obstructive and restrictive defect, only four having normal lung function tests. Sixty-nine percent of subjects tested had a provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) less than 16 mg X ml-1. Subjects with daily sputum production had lower values of FEV1 and FEV1/forced vital capacity (FVC) compared to subjects with less than daily sputum. Subjects with clinical features of bronchial hyperexcitability had significantly lower baseline FEV1, vital capacity, and maximal mid-expiratory flow rate (FEF25-75). Subjects with lower PC20 values had significantly lower baseline FEV1, FEV1/FVC and FEF25-75. Finally, subjects with the greatest extent of radiological abnormalities had lower baseline FEV1, FEV1/FVC and diffusing capacity, and a higher residual volume. We conclude that chronic bronchiectasis is associated with significant changes in lung function tests and increased responsiveness to methacholine in the majority of affected individuals.     

Comparison of roflumilast, an oral anti-inflammatory, with beclomethasone dipropionate in the treatment of persistent asthma

BACKGROUND: Roflumilast is an oral, once-daily phosphodiesterase 4 inhibitor with anti-inflammatory activity in development for the treatment of asthma. Roflumilast was compared with inhaled beclomethasone dipropionate (BDP) in patients with asthma. METHODS: In a double blind, double-dummy, randomized, noninferiority study, 499 patients (forced expiratory volume in 1 s [FEV1] = 50-85% predicted) received roflumilast 500 microg once daily or BDP 200 microg twice daily (400 microg/day) for 12 weeks. Lung function and adverse events were monitored. RESULTS: Roflumilast and BDP significantly improved FEV1 by 12% (270 +/- 30 ml) and 14% (320 +/- 30 ml), respectively (P < 0.0001 vs baseline). Roflumilast and BDP also significantly improved forced vital capacity (FVC) (P < 0.0001 vs baseline). There were no significant differences between roflumilast and BDP with regard to improvement in FEV1 and FVC. Roflumilast and BDP showed small improvements in median asthma symptom scores (-0.82 and -1.00, respectively) and reduced rescue medication use (-1.00 and -1.15 median puffs/day, respectively; P < 0.0001 vs baseline). These small differences between roflumilast and BDP were not considered clinically relevant. Both agents were well tolerated. CONCLUSIONS: Once daily, oral roflumilast 500 microg was comparable with inhaled twice-daily BDP (400 microg/day) in improving pulmonary function and asthma symptoms, and reducing rescue medication use in patients with asthma.     

Effect of sodium cromoglycate on histamine inhalation tests

Sixteen adult asthmatic subjects in a clinical steady state were included in the study. On day 1, after baseline assessment of spirometry (FEV1, FEV1/FVC, FEF25-75), they underwent three to four consecutive inhalation tests using twofold increasing doses of histamine to measure the provocative concentration causing a fall in FEV1 of 20% (PC20). Baseline FEV1 was back to +/- 5% of the initial assessment before each histamine inhalation test (HIT). On days 2, 3, and 4, after baseline spirometry which confirmed that FEV1 was within 10% of initial day 1 assessment, placebo-lactose (P) or 40 mg of sodium cromoglycate (SCG) were nebulized in a double-blind randomized 4.3.1. two-treatment crossover study design. Ten minutes later, spirometry was repeated and followed by an HIT. Baseline spirometry was not significantly different on each day or after P and SCG. There was no statistical difference between the geometric means of the three or four PC20's done on day 1, indicating that there is no tachyphylaxis induced by repeated HIT. There was no statistical difference between mean PC20 after P (0.52 +/- 3.3 (SD) mg/ml), after SCG (0.50 +/- 3.2), and of the three to four HIT done on day 1 (0.40 +/- 3.6). We conclude that in asthmatic subjects SCG has no acute bronchodilator effect and does not alter the response to inhaled histamine.     

Effect of fluticasone propionate at half dose of beclomethasone dipropionate divided twice daily and once daily in asthmatics inhaling beclomethasone dipropionate 800 micrograms daily or more]

We conducted a 12 weeks' single-arm prospective study comparing beclomethasone dipropionate (BDP), 1/2 doses of fluticasone propionate (FP) twice daily and the same dose of FP once daily in 47 asthmatics who had been inhaling BDP 800 mcg daily or more. Peak expiratory flow (PEF), FEV1, a symptom score and a frequency of beta 2 agonist were all significantly better in FP twice daily phase than BDP phase (329 vs. 306 L/min, 1.87 vs. 1.76 L, 3.6 vs. 6.0/week and 2.7 vs. 4.5 puffs/day, respectively). There was no significant difference in these endpoints between FP twice daily phase and FP once daily phase. FP twice daily produced better plumonary function and symptom relief than the double doses of BDP. Furthermore, FP twice daily could, at least in a short-term basis, safely be changed into the same doses of FP once daily.     

Bronchial hyperreactivity after treatment with sodium cromoglycate in atopic asthmatic patients not exposed to relevant allergens

The bronchial hyperreactivity, measured as the responsiveness to histamine, was studied in 14 atopic patients before, during, and after 4 wk of treatment with sodium cromoglycate (SCG) and placebo in a double-blind, randomized, crossover study. The patients were not exposed to relevant allergens during the study. The variations in provocation concentrations corresponding to 20% decrease in FEV1 (PC20) were small during both placebo and active drug treatment. After SCG treatment, PC20 increased (less responsiveness) in nine of the 14 patients, especially in those with low PC20 values. The difference between placebo and active drug treatment was not statistically significant. Although SCG has a mediator-inhibiting effect, this study gave no support for the assumption that inhibition of mediator release leads to a reduction of the bronchial hyperreactivity in atopic asthmatic subjects who are not exposed to relevant allergens.     

Long-term effects of a long-acting beta 2-adrenoceptor agonist, salmeterol, on airway hyperresponsiveness in patients with mild asthma.

BACKGROUND. Asthma is characterized by hyperresponsiveness of the airways to bronchoconstrictive stimuli. Long-acting beta 2-adrenoceptor agonists have been introduced as a new therapeutic approach, but there is growing concern about whether control of asthma may deteriorate with the regular use of these agents. We investigated the long-term effects of the beta 2 agonist salmeterol on bronchodilation and on airway hyperresponsiveness to the bronchoconstrictive agent methacholine in mild asthma. METHODS. In a parallel, double-blind study, 24 patients with mild asthma were randomly assigned to treatment with either inhaled salmeterol (50 micrograms, twice daily) (n = 12) or placebo (n = 12) during an eight-week trial. Methacholine challenge was performed before, during, and after the treatment period. Methacholine responsiveness was measured as the provocative concentration (PC20) that caused a 20 percent decrease in the forced expiratory volume in one second (FEV1). RESULTS. There was a significant increase in FEV1 one hour after the inhalation of salmeterol (P = 0.006), which did not differ significantly on days 0, 28, and 56 of the treatment period (increase, 9.8, 9.4, and 8.8 percent of predicted FEV1, respectively; P = 0.91). On the first treatment day, salmeterol afforded significant protection against methacholine-induced bronchoconstriction, as shown by a 10-fold increase in the PC20 as compared with the value at entry (P less than 0.001). After four and eight weeks of treatment, however, the salmeterol-induced change in the PC20 was significantly attenuated (P less than 0.001) to only a twofold increase. Two and four days after treatment ended, the PC20 was not significantly different from the value before treatment (P = 0.15). CONCLUSIONS. Regular treatment of patients with mild asthma with salmeterol leads to tolerance to its protective effects against a bronchoconstrictor stimulus, in this case inhaled methacholine, despite well-maintained bronchodilation. This finding raises concern about the effectiveness of prolonged therapy with long-acting beta 2-adrenoceptor agonists in asthma.     

The temporal relationship between increases in airway responsiveness to histamine and late asthmatic responses induced by occupational agents

The temporal relationship between increases in airway responsiveness and the late asthmatic response was assessed in nine patients challenged with occupational agents toluene diisocyanate (one patient), carmine (one patient), maleic anhydride (two patients), colophony (four patients), and trimellitic anhydride (one patient). The provocation concentration of histamine causing a 20% decrease in FEV1 (PC20) was measured before challenge and at approximately 3 hours and 24 hours on control and active-challenge days. Thirteen active challenges provoked eight definite late asthmatic responses (maximum fall in FEV1 greater than 15% at 3 to 11 hours). At 3 hours after the challenges that provoked late responses, there was a significant (p less than 0.02) decrease in PC20 that was more (p less than 0.03) than that observed for the five tests provoking early (late FEV1 fall 0% to 5%) or equivocal late (FEV1 fall 6% to 15%) responses. At 24 hours, PC20 remained decreased (p less than 0.05), although it was less so than at 3 hours (p less than 0.05) and not significantly when compared with challenge tests causing single early or equivocal late responses. The 3-hour decreases in PC20 were identified when FEV1 (five of seven observations) was greater than 90% of prechallenge values. For the nine independent tests, the 3-hour decreases in PC20 correlated (r = 0.72; p less than 0.05) with the magnitude of the late falls in FEV1, whereas this was not observed at 24 hours (r = 0.35; p, not significant).(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term prognosis of asthmatic patients treated with low-dose beclomethasone dipropionate]

To clarify the prognosis of asthmatics treated with low-dose of inhaled beclomethasone dipropionate (BDP), we retrospectively assessed 43 patients treated with initial dose of 200 or 400 micrograms/day for 5 years, and obtained the following results. 1) 15 patients achieved step-down therapy (group A), 17 patients maintained initial dose of BDP (group B), and 11 patients required step-up therapy of BDP or daily use of oral prednisolone (group C). 2) There was no significant difference in age, sex, duration of disease, severity of disease, peripheral eosinophil counts, %FEV1 and histamine PC20 before BDP treatment among three groups. The percentage of atopic asthmatics was significantly higher in group C than in group A. 3) There was no significant difference in symptom and histamine PC20 between after 1 year state and after 5 years state in three groups. 4) After 1 year from the start of BDP treatment, only 18% patients got symptom free and neither patients exceeded 20,000 micrograms/ml of histamine PC20 in group C. Long-term treatment of low-dose BDP inhalation was effective on mild/moderate asthmatics. Patients requiring step-up therapy had not got sufficient improvement in bronchial hyperresponsiveness after one-year treatment.     

Effect of beclomethasone increment on airflow limitation in asthmatic children treated with high dose beclomethasone]

In order to evaluate the effect of higher dose BDP therapy (1200-1660 micrograms/day), we studied 12 asthmatic children (mean age 9.7 years-old) with airflow limitation on respiratory function test who were asymptomatic with high-dose BDP therapy (800 micrograms/day). After 4 weeks of higher dose BDP therapy, FVC, FEV1 and V50 were significantly improved, but those improvement were insufficient compared with those after salbutamol inhalation. The personal best values after salbutamol inhalation were not different in every parameter of respiratory function test between BDP 800 micrograms/day and 1200 micrograms/day. We conclude that less than 800 micrograms of daily BDP is generally adequate for prevention in most asthmatic children, because higher dose BDP therapy is no more effective on respiratory function in those treated with 800 micrograms of daily BDP, and that the best value of respiratory function after salbutamol inhalation is not always a goal of high dose BDP therapy.     

Measurement of PC20 histamine with the use of two different nebulizers and measurement of FEV1 and PEF

Histamine challenge was performed in 19 patients using two nebulizers (PARI and Wright) and FEV1 and PEF were measured to determine PC20 histamine. FEV1 and PEF gave identical PC20 histamine values. The PARI nebulizer gave PC20 histamine values that were 2.5 doubling concentrations lower than the Wright nebulizer. The reproducibility of histamine challenge with the PARI nebulizer was studied in 15 patients and the results suggested that the challenge was reproducible within one doubling concentration of histamine.     

Pulmonary function of herdsmen

OBJECTIVE: To determine whether the pulmonary function deficit documented previously in Fulani children is also present in adult Fulani herdsmen in northern Nigeria. SUBJECTS AND METHODS: The subjects for this study consisted of adult Fulani men from the hamlet of Magama Gumau and adult non-Fulani men from the city of Jos. Age, height, weight, mid-arm circumference (MAC), triceps skin-fold thickness, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%), and peak expiratory flow rate (PEF) were measured. Body mass index (BMI) and FEV1/FVC were calculated for all subjects. Multiple regression analysis was performed to identify correlations between pulmonary function parameters and anthropometric variables. RESULTS: The 44 Fulani subjects and 28 urban subjects were well-matched for age and height. The Fulani men weighed significantly less than the urban men (58.5+/-9.4 versus 67.4+/-11.3 kg, p <0.001) and consequently had significantly lower BMI, MAC, and triceps skin-fold thickness. The only significant difference in pulmonary function parameters between the two groups was in FEV1/FVC (0.93+/-0.1 versus 0.85+/-0.1, p <0.001). Small but significant correlations were found between pulmonary function parameters and anthropometric variables for both study populations. CONCLUSIONS: The pulmonary function deficits documented previously in Fulani children and adolescents were not present in adult Fulani men. However, the observed elevation in FEV1/FVC in the rural Fulani men as compared to their urban counterparts, which is often seen in restrictive pulmonary patterns, deserves further study.     

Spirometric response to a bronchodilator. Reference values for healthy children and adolescents

The spirometric response to inhaled salbutamol was assessed in 492 healthy volunteers 6 to 20 yr of age. Mean and standard deviation of the changes, expressed as percentage of prebronchodilator values, were as follows: forced vital capacity (FVC): 1.7 +/- 2.8; forced expiratory volume in one second (FEV1): 3.3 +/- 3.4; (FEV1/FVC): 3.1 +/- 3.2; peak expiratory flow: 6.4 +/- 8.6; maximal mid-expiratory flow: 10.1 +/- 8.8; maximum expiratory flow at 50% of FVC: 8.8 +/- 9.5 and maximum expiratory flow at 25% of FVC: 14.0 +/- 14.7. The changes were significant (p less than 0.005) for all parameters and similar to those observed in adults.     

Postoperative pain relief and respiratory performance after thoracotomy: a controlled trial comparing the effect of epidural morphine and subcutaneous nicomorphine

Twenty patients scheduled for lateral thoracotomy were randomly allocated to receive either epidural morphine at regular intervals or subcutaneous nicomorphine on demand for postoperative pain relief. The daily dose of opiate administered was greater in the group receiving subcutaneous nicomorphine than in the epidural group although four patients in the latter needed additional subcutaneous injections of opiate. During the first three days of the postoperative course, a profound decrease of the forced vital capacity (FVC), the forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF) and the arterial oxygen tension (PaO2) was found in both groups, whereas the visual analogue pain score showed a marked increase, and the arterial pH and carbon dioxide tension (PaCO2) remained unchanged. No significant difference could be demonstrated between the group;s. The conclusion is that epidural morphine may produce sufficient pain relief after thoracotomy, but compared with conventional pain treatment the benefits are limited.     

Changes in bronchial hyperreactivity induced by 4 weeks of treatment with antiasthmatic drugs in patients with allergic asthma: a comparison between budesonide and terbutaline

We performed a double-blind crossover study to compare the effects of long-term treatment of inhaled budesonide and terbutaline on bronchial hyperreactivity in 17 patients with allergic asthma. Both drugs were administered for 4 weeks with a placebo-treatment period before and after each active-treatment period. To assess bronchial hyperreactivity, standardized inhalation provocation tests with histamine and propranolol were performed every 2 weeks. Before each inhalation provocation the drugs were withheld for at least 12 hours. Before the budesonide treatment the FEV1 value (percent predicted) was 85.3 +/- 4.1% (mean +/- SEM). After 2 and 4 weeks of treatment with this drug, the value increased significantly to 89.4 +/- 4.1% and 96.2 +/- 3.8%, respectively (p less than 0.05 and p less than 0.005). The histamine provocation concentrations causing a decrease in FEV1 of 20% (PC20) on the same days were 4.0, 7.2, and 9.5 mg/ml, respectively (both p less than 0.001). The PC20 values for propranolol, which were measured 1 hour after the histamine provocation, were 11.7, 13.3, and 14.0 mg/ml (ns). The FEV1 values before and after 2 and 4 weeks of treatment with terbutaline were 86.2 +/- 4.0%, 84.8 +/- 4.1%, and 87.0 +/- 4.6%, respectively. The histamine PC20 values on the same days were 4.7, 3.1 (p less than 0.05), and 3.8 mg/ml, respectively. The propranolol PC20 values were 14.2, 8.7, and 10.1 mg/ml (p less than 0.001 and p less than 0.05, respectively. We conclude that budesonide improves bronchial hyperreactivity, possibly by a dampening of late allergic reactions, whereas treatment with terbutaline may lead to a temporary increase of bronchial hyperreactivity, possibly as a result of beta-receptor desensitization.     

Grading severity and treatment requirements to control symptoms in asthmatic children and their relationship with airway hyperreactivity to methacholine

Airway hyperreactivity has been proposed to be an important determinant of severity of asthma and medication needs to control symptoms in adults. In this study we tried to determine if this relationship existed in childhood asthma. One hundred and forty-five asthmatic children aged 6 to 19 years with a positive methacholine (MCH) challenge test and a baseline forced expiratory volume in one second (FEV1) of 56% to 118% predicted were studied. The MCH concentration required to decrease the FEV1 from baseline by 20% (PC20) ranged from 0.1 to 20 mg/mL (geometric mean = 1.85 mg/mL). Asthma symptoms in this population before the study ranged from 2 months to 14 years. They were followed for a mean of 10 months after the MCH challenge and then grouped into four groups according to overall severity of symptoms and treatment needed to control symptoms. The first grade was comprised of patients with intermittent symptoms only, with a respiratory tract infection (URTI), and no medication; grade 2 symptoms were severe enough to require intermittent bronchodilators (BD); grade 3 symptoms were severe enough to require daily BD; and grade 4 symptoms were severe enough to require daily BD and steroids. Geometric means PC20 were significantly different among the four groups when they were analyzed by ANOVA P less than .01. There was, however, marked overlap between the individual levels of PC20 among the four groups. There was no significant difference in mean FEV1, age, sex, or duration of symptoms among the four groups. There was no significant correlation between baseline FEV1 and the degree of airway hyperreactivity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relationship between induced sputum cell counts and fluid-phase eosinophil cationic protein and clinical or physiologic profiles in mild asthma.

BACKGROUND: Sputum analysis is the only non-invasive method to examine airway inflammatory processes in subjects with asthma. The aim of this study was to investigate the relationship between cell counts and fluid phase levels in induced sputum in subjects with mild asthma, and the severity of asthma as assessed by clinical, physiologic and blood measurements. METHODS: Forty patients with mild asthma, aged 17 to 49 years were studied (good sputum sample only from 31). On the first day, spirometry and methacholine challenges were performed. After 2 to 4 days, venous blood for absolute eosinophil count and eosinophil cationic protein (ECP) measurement was obtained and sputum was induced by inhalation of hypertonic saline. For the next 15 days subjects recorded their peak expiratory flow (PEF), symptom scores, and beta2-agonist requirements twice daily. Differential counts of leukocytes were done on cytospin preparations of homogenized sputum and the supernatant was examined for eosinophil cationic protein (ECP). RESULTS: Sputum eosinophil counts and not neutrophil, epithelial cells, macrophages, or lymphocytes, were inversely correlated to FEV1/FVC % (r = -.57, P = .0008) and to PC20-methacholine (r = -.40, P = .024). No statistical relationship was obtained between eosinophil counts and either symptom scores, bronchodilator requirements, or daily PEF variability. Sputum ECP values were correlated to FEV1/FVC% (r = -.41, P = .026) but not to PC20 (r = -.32, P = .08) or clinical scores or PEF variation. A trend to significance was appreciated between peripheral blood and sputum eosinophil counts (r = .34, P = .067) and no relationship was found between sputum and serum ECP values (r = .10, P = .38). CONCLUSIONS: Although sputum markers give some information about disordered lung function and physiologic changes in the airways, they are not the only factors concerned in the clinical expression of mild asthma.