Browsing by Author "Beasley R"

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    Enhanced airway sensory nerve reactivity in non-eosinophilic asthma
    (BMJ Publishing Group Ltd and the British Thoracic Society, 2/11/2021) Ali H; Brooks C; Crane J; Beasley R; Holgate S; Gibson P; Pattemore P; Tzeng Y-C; Stanley T; Pearce N; Douwes J
    BACKGROUND: Neural mechanisms may play an important role in non-eosinophilic asthma (NEA). This study compared airway sensory nerve reactivity, using capsaicin challenge, in eosinophilic asthma (EA) and NEA and non-asthmatics. METHODS: Thirty-eight asthmatics and 19 non-asthmatics (aged 14-21 years) underwent combined hypertonic saline challenge/sputum induction, fractional exhaled nitric oxide, atopy and spirometry tests, followed by capsaicin challenge. EA and NEA were defined using a sputum eosinophil cut-point of 2.5%. Airway hyperreactivity was defined as a ≥15% drop in FEV1 during saline challenge. Sensory nerve reactivity was defined as the lowest capsaicin concentration that evoked 5 (C5) coughs. RESULTS: Non-eosinophilic asthmatics (n=20) had heightened capsaicin sensitivity (lower C5) compared with non-asthmatics (n=19) (geometric mean C5: 58.3 µM, 95% CI 24.1 to 141.5 vs 193.6 µM, 82.2 to 456.0; p<0.05). NEA tended to also have greater capsaicin sensitivity than EA, with the difference in capsaicin sensitivity between NEA and EA being of similar magnitude (58.3 µM, 24.1 to 141.5 vs 191.0 µM, 70.9 to 514.0) to that observed between NEA and non-asthmatics; however, this did not reach statistical significance (p=0.07). FEV1 was significantly reduced from baseline following capsaicin inhalation in both asthmatics and non-asthmatics but no differences were found between subgroups. No associations with capsaicin sensitivity and atopy, sputum eosinophils, blood eosinophils, asthma control or treatment were observed. CONCLUSION: NEA, but not EA, showed enhanced capsaicin sensitivity compared with non-asthmatics. Sensory nerve reactivity may therefore play an important role in the pathophysiology of NEA.
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    Protocol for the INFORM ASTHMA Trial: budesonide–formoterol reliever in adults with asthma on maintenance inhaled corticosteroid
    (European Respiratory Society, 2025-07-07) Noble J; Bean O; Bruce P; Black M; Sayers R; Cullen R; Black B; Holliday M; Kirton L; Perry B; Eathorne A; Pavord I; Weatherall M; Beasley R
    Background International asthma guidelines recommend inhaled corticosteroid (ICS)/formoterol in preference to short-acting β2-agonist (SABA) reliever-based regimens as reliever therapy in adults and adolescents of all asthma severities. A major limitation to this recommendation is the absence of randomised controlled trial (RCT) efficacy and safety data for this approach in patients who continue to use maintenance ICS. The anti-inflammatory effect of ICS/formoterol reliever therapy on airway inflammation is also not well characterised. Objective The objective of the present study is to determine the anti-inflammatory effect, efficacy and safety of budesonide–formoterol reliever therapy versus terbutaline reliever therapy in adults with asthma on maintenance ICS therapy. Fractional exhaled nitric oxide (FENO) will specifically be examined to determine the time-course and magnitude of the anti-inflammatory effect. Methods A 26-week, open-label, parallel-group, 2-arm, phase IV, two-sided superiority RCT will recruit 180 adults aged 16–75 years with a clinical diagnosis of asthma using reliever only therapy, or SABA reliever therapy with maintenance ICS at baseline, and with baseline FENO at screening ≥25 ppb. Enrolled participants will be allocated to maintenance budesonide with the dose based on their baseline treatment step and randomised 1:1 to either budesonide–formoterol or terbutaline reliever therapy. All participants will perform at-home FENO measurements at regular intervals for the first 12 weeks of the study. The primary outcome is FENO at 26 weeks. Key secondary outcomes include FENO time-course, asthma exacerbations, asthma control and spirometry. Conclusion This will be the first RCT comparing ICS/formoterol versus SABA reliever therapy in patients who use maintenance ICS therapy.