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The urinary cortisol was measured using a commercial radioimmunoassay kit (DiaSorin Ltd, Wokingham, Berkshire, UK), which has no cross reactivity with fluticasone. The intra assay coefficient of variation was 4% and the inter assay coefficient of variation was 8%. Urinary creatinine was measured on a Cobas-Bio auto analyser (Roche Products, Welwyn Garden City, UK). The intra assay and inter assay co-efficient of variation was 4.6% and 3% respectively. spss version 14 (SPSS Inc., Chicago, IL, USA) was used to carry out the statistical analysis. A sample size of 24 completed patients was estimated to give 80% power to detect a one doubling-dilution shift (minimal important difference or MID) in methacholine PC20 value (primary endpoint) assuming a 0.84 within-patient SD for this outcome. The sample size estimations were supported by prior studies from our department and external data published to assist sample size calculations (20�C22). Datasets were analysed for patients who completed the crossover study per protocol. Data were assessed for normality using visual inspection, Q�CQ plots and with previous consideration for literature, and if appropriate non- Gaussian data was logarithmically transformed prior to analyses. Comparisons were made using an overall repeated measures anova (adjusted for baselines) with Bonferroni correction for multiple comparisons (P? reasons or illness unrelated to asthma and one subject had an exacerbation of asthma during washout prior to final randomized trial intervention and hence withdrawn. One additional subject was excluded from analysis as his methacholine PC20 was >4?mg/ml at baseline and hence should not have been permitted to continue in accordance with the trial protocol. Thus data from these 25 subjects were included in the final per-protocol analysis (Table?1). There was no significant difference in baseline and washout values for the primary outcome with respect to treatment or sequence (data not shown) thus ruling out a carryover effect. Similarly, there were no significant differences in the pretreatment baselines for all secondary outcomes except exhaled nitric oxide and rhinitis quality of life. Treatment effects are therefore presented as differences from respective pretreatment baselines. For the primary outcome measure of methacholine PC20, all three treatments conferred significant improvements from respective pretreatment baseline (Table?2). Low dose fluticasone produced a 1.20 doubling-dilution shift (95% CI, 0.63, 1.77; P?