| Summary: | Patients with difficult to manage asthma and chronic cough are commonly seen by respiratory physicians in the NHS. This thesis describes three randomised trials which explore new treatment options for these difficult groups. Non-invasive markers of airway inflammation and function were measured before each trial to help determine likely responders. In the first study, 30 patients with asthma and eosinophilic inflammation were given two weeks of prednisolone and then randomised to receive either ciclesonide 360mcg or placebo twice daily for 8 weeks. Though the between- group differences were not significant several patients had changed their usual maintenance dose of prednisolone during the trial. When these patients were removed from the analysis there was a significant improvement sputum eosinophils with ciclesonide. There was no significant change in the marker of small airway inflammation, so it is possible that this effect was due to a general reduction in airway inflammation from the higher dose of inhaled steroids, rather than specifically targeting the small airways. In the second study, 28 patients with refractory asthma were given azithromycin 250mg or placebo three times weekly for six weeks in a randomised, cross-over design. Though significant improvements in airway hyper-responsiveness, asthma control and sputum neutrophils were seen with azithromycin, these changes were not significant when compared to placebo.
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