<Originals>An empirical trial of one-week treatment with inhaled orticosteroids for distinguishing asthmatic syndrome from asthma mimics
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[Abstract] Asthma is a complex clinical disease characterized by airway hyperresponsiveness and airway inflammation. It is commonly diagnosed and treated on the basis of the clinical impression of the physician, although national guidelines recommend documenting reversible airflow obstruction. sthma-like symptoms are shown in asthma mimics, including mitral valve disorder, allergic rhinitis and Sjogren's syndrome. This study examined whether a response to 1 week of inhaled corticosteroids (ICS) was useful for distinguishing asthma mimics from asthmatic syndrome, including definitive asthma andeosinophilic bronchitis. This study included 126 subjects who had episodes of wheezing at night and/or in the early morning. Airway hyperresponsiveness(AHR), bronchodilator reversibility (BR), and eosinophilia in sputum (Eo) were measured. Asthma was diagnosed by a classical definition for asthma determination proposed by the Ciba symposium, and clinical observation for 2 years. The clinical response to the treatment was assessed based on the symptom score on a visual-analogue scale and the clinical peak-expiratory flow rate (PEFR) within the first week after treatment with ICS. In total, 110 of the 126 subjects (87％) were diagnosed with asthmatic syndrome, as either definitive asthma (72％) or eosinophilic bronchitis (15％), whereas the remaining 16 participants were considered to have asthma mimics due to an alternative diagnosis. Patients with definitive asthma and eosinophilic bronchitis, but not those with asthma mimics, showed improved symptom scores and their clinical PEFR was improved within the first week of ICS treatment. In this study, we demonstrated that diagnosis using the patient response to ICS was an effective alternative tool for distinguishing asthmatic syndrome from asthma mimics.
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