P163 Inhaled and oral corticosteroid treatment highlights differential effects in blood and airway compartments in type-2 high asthma
Bibliographic record
Abstract
Exhaled nitric oxide (FeNO) and blood eosinophilia are important biomarkers of type-2 inflammation with additive predictive value in asthma. We have shown that high FeNO correlates with chemokines and cytokines involved in epithelial signalling whilst blood eosinophil levels correlate with serum interleukin-5 only.1 This suggests that FeNO more accurately reflects inflammation in the airway ‘compartment’ and blood eosinophil count reflects the systemic ‘compartment’ in eosinophilic asthma. We now test the hypothesis that the effect of low dose inhaled corticosteroids and oral corticosteroids, both effective treatments for eosinophilic airway inflammation, have differential effects on the airway (reflected by FeNO) and systemic compartment (reflected by blood eosinophils) in patients with eosinophilic asthma. Corticosteroid-naïve patients were assessed before and after 8 weeks of 200 mcg twice daily beclomethasone via aero-chamber. Patients with eosinophilic asthma established on inhaled treatment were assessed before and after 10 days of 30 mg prednisolone daily. Patients were at steady state and had evidence of type-2 airway inflammation reflected by either baseline FeNO >45ppb and/or blood eosinophils >0.30x109/L. 11 patients were recruited to the ICS group and 13 to the OCS group. Groups were matched for age but not baseline FEV1. Low-dose ICS produced a large median decrease in FeNO of 53.5%, p < 0.002, 95% CI [36.1, 71.0] and a small decrease in blood eosinophilia of 18.8% p < 0.005, 95% CI [6.5, 42.8] (figure 1). By contrast, OCS resulted in a comparatively smaller reduction in FeNO of 34.8%, p < 0.001, 95% CI [18.0, 51.5] but a large decrease in blood eosinophils of 80.3%, p < 0.001, 95% CI [64.3, 92.3]. These results suggest inhaled and oral steroids act differentially in the airway and blood compartments. The relative resistance to inhaled corticosteroids identified in some patients with type-2 high asthma, and the comparative success of oral therapy in this group, may reflect a greater contribution from the systemic reservoir of blood eosinophils. Reference Couillard S, Shrimanker R, Chaudhuri R, et al. Fractional Exhaled Nitric Oxide Non-suppression Identifies Corticosteroid-Resistant Type 2 Signaling in Severe Asthma. Am J Respir Crit Care Med. 2021;204(6):731–734.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".