The Use of FKBP51 in the Identification of Non-adherence to Inhaled Corticosteroids in Difficult Asthma

Inclusion Criteria: This pilot study will investigate the following groups (n=10 per group): 1. Healthy volunteers. 2. Steroid naïve asthmatics. 3. Refractory asthmatics adherent to high dose inhaled steroids. 4. Non-adherent asthmatics. Inclusion Criteria For inclusion into this study all participants must: * be 16 years old or older * give written informed consent Healthy volunteers must: * be in good general health as determined by past medical history and physical. * have no other significant medical history and specifically no prior history of asthma or persistent respiratory symptoms. * normal spirometry. Steroid naïve subjects * have a diagnosis of asthma * receiving treatment at Step 1 BTS/SIGN Guidelines i.e. no inhaled steroid Non-adherent subjects must * have a diagnosis of asthma * be non-adherent to ICS as determined by ICS prescription filling of \</=50% in the previous 6 months Refractory asthmatic adherent subjects must: * have a diagnosis of asthma receiving high dose ICS treatment (beclomethasone equivalent dose \> 1000 µg per day) * be adherent to ICS as determined by ICS prescription filling \>75% in the previous 6 months Exclusion Criteria: Participants who fulfill the following criteria will be excluded from study entry: * Current smoker, * Pregnant or lactating, * Other significant respiratory disease * Previous allergic reaction or known hypersensitivity to budesonide or any corticosteroid Healthy volunteers will be excluded if they have / are : * any significant medical history which the principal investigator (PI) deems appropriate to be excluded from the healthy control group * obstructive lung function * taking any medication * a current or history of drug or alcohol abuse * any significant illness during the screening period preceding entry into the study Steroid naïve / Non-adherent asthmatics will be excluded if they have: * commenced or increase of oral corticosteroids in the previous 28 days * a concurrent asthma exacerbation Refractory / Adherent asthmatics will be excluded if they have: * commenced or increased of oral corticosteroids in the previous 28 days * a concurrent asthma exacerbation