Background: While most of the clinical benefits of inhaled corticosteroid (ICS) therapy may occur at low doses,\r\nresults of dose-ranging studies are inconsistent. Although symptom/lung function response to low and high dose\r\nICS medication is comparable, it is uncertain whether low dose ICSs are as effective as high dose in the treatment\r\nof inflammation and remodeling.\r\nMethods: 22 mild or moderate asthmatic adult subjects (corticosteroid free for > 2 months) participated in a\r\nrandomized, parallel group study to compare effects of fluticasone propionate (FP) 200 mcg/day and 1000 mcg/\r\nday. Alveolar macrophage (AM)-derived cytokines and basement membrane thickness (BMT) were measured at\r\nbaseline and after 7 weeks treatment while symptoms, spirometry, exhaled nitric oxide (eNO) and airway\r\nhyperresponsiveness (AHR) to mannitol at baseline and 6 weeks.\r\nResults: FP improved spirometry, eNO, symptoms and AHR with no difference between low and high dose FP.\r\nBoth high and low dose FP reduced GM-CSF, TNF-alpha and IL-1ra, with no change in BMT and with no\r\ndifferences between low and high dose FP.\r\nConclusions: 200 �µg/day of FP was as effective as 1000 �µg/day in improving asthma control, airway inflammation,\r\nlung function and AHR in adults in the short term. Future studies should examine potential differential effects\r\nbetween low and high dose combination therapy (ICS/long acting beta agonist) on inflammation and airway\r\nremodeling over longer treatment periods.
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