الفهرس 
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Abstract
In this study we sought to determine whether recommended doses of inhaled steroids for the treatment of moderate to severe persistent asthma alter CMI. We chose to examine delayed cutaneous hypersensitivity (DCH) as markers of CMI.
The present study was performed on100 patients, 60 with bronchial Asthma (34 males and 26 females) taken from asthma clinic, in Elfashn chest hospital Banisuif governenate . The cases were diagnosed on clinical & laboratory basis recurrent attacks of cough, wheezes and chest tightness that were reversible spontaneously or with bronchodilator therapy.
The studied patients were subdivided according to the severity of symptoms an signs of asthma into three groups
Group1 mild asthma 18 patients 11 male and 7 female.
Group2 moderate asthma 21 patients 11 male and 10 female.
Group3severe asthma 21 patients 12 male and 9 female.
Group4 forty asthmatic individuals were taken as control group.
For groups 1,2,3, Each patient was subjected to the following:
1- A detailed history including drug history especially inhaled or systemic steroids.
2- Full clinical examination.
3- Chest radiography.
4-Erythrocyte sedimentation rate.
5- Tuberculin skin test
6- Treatment with inhaled steroids in dose of 50ugm beclomehasone
diproppinate will be administrated through metered dose inhaler (MDI) three times per day for three months beside the usual bronchodilators.
7-Repetition of tuberculin skin test after three months.
8-Assessment of the difference in the result of tuberculin testing at
baseline and after three months will be done.
9- Sputum analysis for Acid Fast Bacilli using Ziehl-Neelsenstain
10-Statistical analysis will be done
The forty individuals who not receive inhaled steroid will act as control group and will be subjected to tuberculin testing only at beginning and at the end of the period .
The statistical analysis prove statistically significant change (from negative to positive) of tuberculin skin test in severe asthmatic group by 30% (4/21) patients with mean PEFR 253.3 range from 180-310, also we demonstrate statistically significant increase of mean ESR by 30% compared to baseline (using willcoxon sign test)
On the other hand there is statistically significant change in radiological finding from normal X-ray to positive X-ray finding (tuberculous cavity in one patient, tuberculous lobar pneumonia in two patints and patchy pneumonia with hilar lymphadenopathy in one patient) by 19% in the same group.
Also we demonstrate statisticall significant change in sputum analysis for acid fast bacilli (AFB) whish become positive in three patients 14% (3/21) in the same group whish prove that this patients have pulmonary tuberculosis either new infection or reactivation of latent infection.