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|Title:||The use of induced sputum in the clinical assessment and management of asthma|
|Authors:||Green, Ruth H.|
|Abstract:||Asthma is a disease characterised by airway inflammation, which is predominantly eosinophilic. Recent developments in the technique of sputum induction have provided a safe non-invasive method of measuring airway inflammation that can be applied to wide populations of patients with asthma and other airway diseases. This thesis explores the use of induced sputum to measure airway inflammation in the assessment and management of adults with asthma. It provides the first evidence that the use of this technique in the management of asthma leads to improved patient outcomes. I have employed induced sputum to assess lower airway inflammation in a large population of patients with symptomatic mild to moderate asthma and have demonstrated considerable heterogeneity of the inflammatory response. I have identified a population of patients with isolated neutrophilic airway inflammation and have provided evidence that such patients respond poorly to inhaled corticosteroid treatment. I have described a management strategy directed at normalising the sputum eosinophil count, as well as controlling symptoms and peak flow readings. I have shown that this management strategy leads to a dramatic reduction in severe asthma exacerbations and prevents hospital admissions compared to a traditional clinical approach and that eosinophilic inflammation is an important risk factor for severe asthma exacerbations. Finally, I report that amongst patients with asthma who remain symptomatic despite low dose inhaled corticosteroids, high dose inhaled corticosteroids and long acting -agonists have contrasting effects on symptoms, lung function and the sputum eosinophil count, suggesting that there is a dissociation between eosinophilic airway inflammation, day-to-day symptoms and variable airflow obstruction in asthma. These findings suggest that the regular monitoring of airway inflammation may be required for optimal asthma management.|
|Rights:||Copyright © the author. All rights reserved.|
|Appears in Collections:||Theses, College of Medicine, Biological Sciences and Psychology|
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