Serum prednisolone levels as a marker of oral corticosteroid adherence in severe asthma
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RESEARCH ARTICLE
Open Access
Serum prednisolone levels as a marker of oral corticosteroid adherence in severe asthma J. Michael Ramsahai1,2* , Emily King1, Robert Niven3, Gael Tavernier3, Peter A. B. Wark1 and Jodie L. Simpson1
Abstract Background: Severe asthma is a complex heterogeneous disease typically requiring advanced therapies. Underlying the treatment of all asthma, however, is the consistent recommendation across international guidelines to ensure that adherence to therapy is adequate. Currently, there is no consensus on an objective marker of adherence. Methods: We performed a prospective observational study of 17 participants taking oral prednisolone using serum prednisolone levels as a marker of adherence, and sputum eosinophilia as a marker of control of type 2 airway inflammation. Based on these biomarkers, we classified participants into a non-adherent and an adherent cohort, and further stratified by the presence of ongoing sputum eosinophilia. Results: We identified 3 non-adherent participants and 14 who were adherent, based on their serum prednisolone levels. Stratification using sputum eosinophil counts identified one participant as having ongoing sputum eosinophilia in the setting of non-adherence, while six were identified as steroid resistant with ongoing sputum eosinophilia despite adherence to oral prednisolone therapy. Conclusion: Serum prednisolone can be used an objective marker of adherence in those patients with severe asthma taking daily oral prednisolone. In combination with sputum eosinophil counts, a steroid resistant cohort can be distinguished from one with ongoing inflammation in the setting of non-adherence. This information can then be used by clinicians to differentiate the optimal next steps for treatment in these specific populations. Trial registration: Participants were recruited as part of the Markers of Inflammation in the Management of Severe Asthma (MIMOSA) study, trial registration ACTRN12616001015437, 02 August 2016. Keywords: Asthma, Airway markers, Eosinophils, Inflammation, Clinical respiratory medicine, Severe asthma, Biomarkers, Adherence, Prednisolone
* Correspondence: [email protected] 1 Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Level 2 West, Lot 1 Kookaburra Cir, New Lambton, Newcastle, NSW 2305, Australia 2 Division of Respirology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unles
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