Assessment of inflammatory characteristics and cell function with changes in asthma control

A group of adult asthmatics (recruited through general practice and advertisement) will be asked if they are amenable to a tailored change in their current asthma treatment. Change in treatment will be made on an individual basis by the supervising clinician according to the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (EPR 3) guidelines, in which asthma control status is based on asthma control questionnaire (ACQ) 7 score, An ACQ-7 score <0.75 will be considered adequately controlled, ACQ-7 >1.5 will be considered inadequately controlled. Once asthma control status/treatment has been ascertained, participants will undergo a clinical assessment (including sputum induction). Group 1: Subjects with adequately controlled asthma (as determined on initial visit) will have their current treatment sub-optimised to a reduced dose of their currently used inhaled corticosteroids (ICS) or to no ICS. The reduction in ICS dose will discussed and agreed with the participant, and will be between 250-1000 mcg budesonide equivalent dose per day. They will then be monitored over a 4-6 week period by weekly review appointments and phone calls (as required) with the supervising physician to assess symptoms, lung function, adherence to ICS dose, and loss of control (based on the criteria of Jone SL et al, Am J Resp Crit Care Med 2001; 164; 738-743). Briefly, this includes the onset of distressing or intolerable asthma symptoms, night wakening with asthma symptoms on more than 3 nights per week, or increase in bronchodilator use of >3 puffs daily. After the 4-6 week period, participants will undergo a further clinical assessment (including sputum induction). Group 2: Subjects with inadequately controlled asthma (as determined on initial visit) will have their treatment optimised and either commence ICS use or increase their current ICS dose. The increase in ICS dose will discussed and agreed with the participant, and will be between 250-1000 mcg budesonide equivalent dose per day. They will then be monitored over a 4-6 week period by weekly review appointments and phone calls (as required) with the supervising physician to assess symptoms, lung function, adherence to ICS dose, and changes in asthma control (as described for group 1), and then undergo a further clinical assessment (including sputum induction). As this is a pilot/feasibility study, the duration between assessments (4-6 weeks) will be flexible and based on the availability of both participant and research team. All participants will continue to use short-acting beta-agonists (SABA) as required, and at the end of the study/time of the second sputum induction, asthma treatment will be adjusted for all subjects according to their asthma control.