BACKGROUND: Asthma guidelines recommend reducing the dose of inhaled corticosteroids after establishing control. OBJECTIVE: To identify predictors of loss of control and the kinetics of symptoms, and inflammatory and physiological measurements when inhaled corticosteroids are reduced in patients with stable asthma. PATIENTS AND METHODS: In a single-blind study, the daily dose of inhaled corticosteroid was reduced by one-half at intervals of 20+/-2 days in 17 adults with controlled asthma until loss of asthma control occurred or until the corticosteroid was replaced with placebo for 20 days. The patients recorded symptoms and peak expiratory flow each day, and forced expiratory volume in 1 s (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20), exhaled nitric oxide, and eosinophils in sputum and blood were measured every 10 days. A loss of asthma control was defined as a worsening of the symptoms score of at least 20%, and either a decrease in FEV1 of at least 15% or a decrease in PC20 of at least fourfold. RESULTS:Two patients had a respiratory infection and were withdrawn from the study. In eight patients, asthma became uncontrolled after a mean of 33 days (range 13 to 48 days). This was accurately reflected by a worsening of all parameters. The first parameter to change was the sputum eosinophil percentage (20 days before the loss of asthma control). Significant changes in exhaled nitric oxide, FEV1 and methacholine PC20 were observed only when the symptoms became uncontrolled. A high blood eosinophil count at baseline (risk ratio of 2.5, 95% CI 1.0 to 6.5) and an increase in sputum eosinophil count after the reduction of corticosteroids were predictors of loss of asthma control. CONCLUSION: In patients whose asthma is controlled on inhaled corticosteroid, it is prudent not to reduce the dose further if the blood eosinophils are increased or if the sputum eosinophils increase by as little as 1% after the reduction of corticosteroids.
RCT Entities:
BACKGROUND:Asthma guidelines recommend reducing the dose of inhaled corticosteroids after establishing control. OBJECTIVE: To identify predictors of loss of control and the kinetics of symptoms, and inflammatory and physiological measurements when inhaled corticosteroids are reduced in patients with stable asthma. PATIENTS AND METHODS: In a single-blind study, the daily dose of inhaled corticosteroid was reduced by one-half at intervals of 20+/-2 days in 17 adults with controlled asthma until loss of asthma control occurred or until the corticosteroid was replaced with placebo for 20 days. The patients recorded symptoms and peak expiratory flow each day, and forced expiratory volume in 1 s (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20), exhaled nitric oxide, and eosinophils in sputum and blood were measured every 10 days. A loss of asthma control was defined as a worsening of the symptoms score of at least 20%, and either a decrease in FEV1 of at least 15% or a decrease in PC20 of at least fourfold. RESULTS: Two patients had a respiratory infection and were withdrawn from the study. In eight patients, asthma became uncontrolled after a mean of 33 days (range 13 to 48 days). This was accurately reflected by a worsening of all parameters. The first parameter to change was the sputum eosinophil percentage (20 days before the loss of asthma control). Significant changes in exhaled nitric oxide, FEV1 and methacholine PC20 were observed only when the symptoms became uncontrolled. A high blood eosinophil count at baseline (risk ratio of 2.5, 95% CI 1.0 to 6.5) and an increase in sputum eosinophil count after the reduction of corticosteroids were predictors of loss of asthma control. CONCLUSION: In patients whose asthma is controlled on inhaled corticosteroid, it is prudent not to reduce the dose further if the blood eosinophils are increased or if the sputum eosinophils increase by as little as 1% after the reduction of corticosteroids.
Authors: J D Leuppi; C M Salome; C R Jenkins; S D Anderson; W Xuan; G B Marks; H Koskela; J D Brannan; R Freed; M Andersson; H K Chan; A J Woolcock Journal: Am J Respir Crit Care Med Date: 2001-02 Impact factor: 21.405
Authors: M M Pizzichini; E Pizzichini; L Clelland; A Efthimiadis; I Pavord; J Dolovich; F E Hargreave Journal: Eur Respir J Date: 1999-01 Impact factor: 16.671
Authors: Aaron Deykin; Stephen C Lazarus; John V Fahy; Michael E Wechsler; Homer A Boushey; Vernon M Chinchilli; Timothy J Craig; Emily Dimango; Monica Kraft; Frank Leone; Robert F Lemanske; Richard J Martin; Gene R Pesola; Stephen P Peters; Christine A Sorkness; Stanley J Szefler; Elliot Israel Journal: J Allergy Clin Immunol Date: 2005-04 Impact factor: 10.793
Authors: J C in't Veen; H H Smits; P S Hiemstra; A E Zwinderman; P J Sterk; E H Bel Journal: Am J Respir Crit Care Med Date: 1999-07 Impact factor: 21.405
Authors: L Jayaram; M M Pizzichini; R J Cook; L-P Boulet; C Lemière; E Pizzichini; A Cartier; P Hussack; C H Goldsmith; M Laviolette; K Parameswaran; F E Hargreave Journal: Eur Respir J Date: 2006-03 Impact factor: 16.671
Authors: T Haahtela; M Järvinen; T Kava; K Kiviranta; S Koskinen; K Lehtonen; K Nikander; T Persson; O Selroos; A Sovijärvi Journal: N Engl J Med Date: 1994-09-15 Impact factor: 91.245
Authors: R A Mcivor; E Pizzichini; M O Turner; P Hussack; F E Hargreave; M R Sears Journal: Am J Respir Crit Care Med Date: 1998-09 Impact factor: 21.405
Authors: E Pizzichini; M M Pizzichini; A Efthimiadis; S Evans; M M Morris; D Squillace; G J Gleich; J Dolovich; F E Hargreave Journal: Am J Respir Crit Care Med Date: 1996-08 Impact factor: 21.405
Authors: M Bradley Drummond; Stephen P Peters; Mario Castro; Janet T Holbrook; Charles G Irvin; Lewis J Smith; Robert A Wise; Elizabeth A Sugar Journal: J Asthma Date: 2011-10-27 Impact factor: 2.515
Authors: Stephanie Korn; Peter Howarth; Steven G Smith; Robert G Price; Steven W Yancey; Charlene M Prazma; Elisabeth H Bel Journal: Respir Res Date: 2022-03-04
Authors: Jasper H Kappen; Elisabeth F C van Rossum; Jan A Witte; Gert-Jan Braunstahl; Wouter J B Blox; Susan C van 't Westeinde; Johannes C C M In 't Veen Journal: BMC Pulm Med Date: 2022-02-05 Impact factor: 3.317