RATIONALE: Current guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required. OBJECTIVES: To evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma. METHODS: In this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250 microg/day for 3 months followed by 100 microg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit. RESULTS:Fifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC20 methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n=33) and in fluticasone-treated (n=24) asthmatic subjects (p=0.03). An additional improvement in PC20 up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p=0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250 microg/day compared with placebo (p<0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups. CONCLUSION: In mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range.
RCT Entities:
RATIONALE: Current guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required. OBJECTIVES: To evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma. METHODS: In this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250 microg/day for 3 months followed by 100 microg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit. RESULTS: Fifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC20 methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n=33) and in fluticasone-treated (n=24) asthmatic subjects (p=0.03). An additional improvement in PC20 up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p=0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250 microg/day compared with placebo (p<0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups. CONCLUSION: In mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range.
Authors: Michael E Wechsler; Stanley J Szefler; Victor E Ortega; Jacqueline A Pongracic; Vernon Chinchilli; John J Lima; Jerry A Krishnan; Susan J Kunselman; David Mauger; Eugene R Bleecker; Leonard B Bacharier; Avraham Beigelman; Mindy Benson; Kathryn V Blake; Michael D Cabana; Juan-Carlos Cardet; Mario Castro; James F Chmiel; Ronina Covar; Loren Denlinger; Emily DiMango; Anne M Fitzpatrick; Deborah Gentile; Nicole Grossman; Fernando Holguin; Daniel J Jackson; Harsha Kumar; Monica Kraft; Craig F LaForce; Jason Lang; Stephen C Lazarus; Robert F Lemanske; Dayna Long; Njira Lugogo; Fernando Martinez; Deborah A Meyers; Wendy C Moore; James Moy; Edward Naureckas; J Tod Olin; Stephen P Peters; Wanda Phipatanakul; Loretta Que; Hengameh Raissy; Rachel G Robison; Kristie Ross; William Sheehan; Lewis J Smith; Julian Solway; Christine A Sorkness; Lisa Sullivan-Vedder; Sally Wenzel; Steven White; Elliot Israel Journal: N Engl J Med Date: 2019-09-26 Impact factor: 91.245
Authors: Helen K Reddel; Eric D Bateman; Allan Becker; Louis-Philippe Boulet; Alvaro A Cruz; Jeffrey M Drazen; Tari Haahtela; Suzanne S Hurd; Hiromasa Inoue; Johan C de Jongste; Robert F Lemanske; Mark L Levy; Paul M O'Byrne; Pierluigi Paggiaro; Soren E Pedersen; Emilio Pizzichini; Manuel Soto-Quiroz; Stanley J Szefler; Gary W K Wong; J Mark FitzGerald Journal: Eur Respir J Date: 2015-07-23 Impact factor: 16.671
Authors: W W Busse; E D Bateman; P M O'Byrne; J Lötvall; A Woodcock; H Medley; R Forth; L Jacques Journal: Allergy Date: 2014-08-22 Impact factor: 13.146