Naomi Tsurikisawa1, Chiyako Oshikata2, Toshio Sato3, Goro Kimura4, Masami Mizuki5, Takahiro Tsuburai6, Shunsuke Shoji7, Hiroshi Saito6, Terufumi Shimoda8. 1. Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama, Japan; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan. Electronic address: User831328@aol.com. 2. Department of Respirology, National Hospital Organization Saitama National Hospital, Saitama, Japan; Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan. 3. Department of Respirology, National Hospital Organization Okayama Medical Center, Okayama, Japan. 4. Department of Respirology and Allergy, National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan. 5. Department of Respirology, National Hospital Organization Morioka National Hospital, Iwate, Japan. 6. Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan. 7. Department of Allergy, National Hospital Organization Tokyo National Hospital, Tokyo, Japan. 8. National Hospital Organization Fukuoka Hospital, Fukuoka, Japan.
Abstract
BACKGROUND: The prognosis for patients beyond 1 year after reduction of their inhaled corticosteroid (ICS) dose remains unknown. Predictive factors that can be evaluated before the initiation of asthma treatment or at ICS dose reduction are unknown. METHODS: We prospectively studied 223 patients in 6 hospitals in the National Hospital Organization of Japan during the 36 months after 50% reduction of their daily ICS dose. All patients recorded their morning and evening peak expiratory flows (PEFs) in their diaries. Lung function, bronchial hyperresponsiveness, fractional nitric oxide levels, number of eosinophils in sputum, and serum IgE levels were measured in most patients. Serum levels of IL-10, IL-33, and thymic stromal lymphopoietin before ICS dose reduction were measured in all patients. RESULTS: During the 36-month study period, asthma control was retained in 127 (59.6%) of the 213 enrolled patients who underwent ICS dose reduction. Multivariate logistic regression analysis revealed that, at the initiation of dose reduction, the factors most predictive of maintenance of asthma control after ICS dose reduction were a low serum IL-33 level (P < .01), low PEF variability over 1 week (P = .014), childhood onset of asthma (at age <10 years) (P = .03), and high serum IL-10 level (P = .035). CONCLUSIONS: We demonstrated that low PEF variability over 1 week, high serum IL-10 level, and low serum IL-33 concentration were useful factors for predicting that an adult's asthma will remain in control for months to years after a 50% reduction in the daily ICS dose.
BACKGROUND: The prognosis for patients beyond 1 year after reduction of their inhaled corticosteroid (ICS) dose remains unknown. Predictive factors that can be evaluated before the initiation of asthma treatment or at ICS dose reduction are unknown. METHODS: We prospectively studied 223 patients in 6 hospitals in the National Hospital Organization of Japan during the 36 months after 50% reduction of their daily ICS dose. All patients recorded their morning and evening peak expiratory flows (PEFs) in their diaries. Lung function, bronchial hyperresponsiveness, fractional nitric oxide levels, number of eosinophils in sputum, and serum IgE levels were measured in most patients. Serum levels of IL-10, IL-33, and thymic stromal lymphopoietin before ICS dose reduction were measured in all patients. RESULTS: During the 36-month study period, asthma control was retained in 127 (59.6%) of the 213 enrolled patients who underwent ICS dose reduction. Multivariate logistic regression analysis revealed that, at the initiation of dose reduction, the factors most predictive of maintenance of asthma control after ICS dose reduction were a low serum IL-33 level (P < .01), low PEF variability over 1 week (P = .014), childhood onset of asthma (at age <10 years) (P = .03), and high serum IL-10 level (P = .035). CONCLUSIONS: We demonstrated that low PEF variability over 1 week, high serum IL-10 level, and low serum IL-33 concentration were useful factors for predicting that an adult's asthma will remain in control for months to years after a 50% reduction in the daily ICS dose.