Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics
Background: Treatment guidelines recommend the use of inhaled corticosteroids (ICS) as first-line therapy for all stages of persistent asthma. However, it is unknown whether ICS dose reduction in adult asthmatics is compatible with maintaining asthma control. Moreover, there are no predictors of eff...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2012-01-01
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| Series: | Allergology International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1323893015302380 |
| _version_ | 1831700912990584832 |
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| author | Naomi Tsurikisawa Chiyako Oshikata Takahiro Tsuburai Chihiro Mitsui Hidenori Tanimoto Kentaro Takahashi Kiyoshi Sekiya Takuya Nakazawa Kenji Minoguchi Mamoru Otomo Yuji Maeda Hiroshi Saito Kazuo Akiyama |
| author_facet | Naomi Tsurikisawa Chiyako Oshikata Takahiro Tsuburai Chihiro Mitsui Hidenori Tanimoto Kentaro Takahashi Kiyoshi Sekiya Takuya Nakazawa Kenji Minoguchi Mamoru Otomo Yuji Maeda Hiroshi Saito Kazuo Akiyama |
| author_sort | Naomi Tsurikisawa |
| collection | DOAJ |
| description | Background: Treatment guidelines recommend the use of inhaled corticosteroids (ICS) as first-line therapy for all stages of persistent asthma. However, it is unknown whether ICS dose reduction in adult asthmatics is compatible with maintaining asthma control. Moreover, there are no predictors of efficacy in maintaining asthma control upon ICS reduction.
Methods: We recruited 90 adult patients with moderate or severe asthma but no clinical symptoms of asthma for at least 6 months. All patients reduced their ICS doses by half but continued taking other asthma-related medications. As a primary outcome, we measured asthma exacerbations during the 12 months following ICS reduction. We also further monitored patients from the above study who had maintained total asthma control for 12 months after ICS reduction and who had continued on their reduced doses of ICS or had further reduced, or stopped, their ICS.
Results: Forty of ninety patients (44.4%) experienced exacerbations after ICS reduction (time to first exacerbation: 6.4±3.6 months). Multivariate logistic regression modeling revealed a rank order of predictors of success in ICS reduction while retaining asthma control: acetylcholine (ACh) PC20 (p<0.01); length of time with no clinical symptoms before ICS reduction (p<0.01); FeNO (p=0.028); and forced expiratory volume in 1 s (FEV1; % predicted) (p=0.03). Finally thirty-nine of 50 patients maintained total asthma control for at least 2 years after the initial ICS reduction.
Conclusions: In asthma patients with normalized AChPC20 of 20 mg/mL or 10 mg/mL and no clinical symptoms for at least 12 or 24 months it may be possible to successfully reduce ICS without increasing exacerbations for long time. |
| first_indexed | 2024-12-20T14:50:03Z |
| format | Article |
| id | doaj.art-9d1e14a0af12441b808b0e17fba16d11 |
| institution | Directory Open Access Journal |
| issn | 1323-8930 |
| language | English |
| last_indexed | 2024-12-20T14:50:03Z |
| publishDate | 2012-01-01 |
| publisher | Elsevier |
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| series | Allergology International |
| spelling | doaj.art-9d1e14a0af12441b808b0e17fba16d112022-12-21T19:36:59ZengElsevierAllergology International1323-89302012-01-0161341942910.2332/allergolint.11-OA-0402Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult AsthmaticsNaomi Tsurikisawa0Chiyako Oshikata1Takahiro Tsuburai2Chihiro Mitsui3Hidenori Tanimoto4Kentaro Takahashi5Kiyoshi Sekiya6Takuya Nakazawa7Kenji Minoguchi8Mamoru Otomo9Yuji Maeda10Hiroshi Saito11Kazuo Akiyama12Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.Background: Treatment guidelines recommend the use of inhaled corticosteroids (ICS) as first-line therapy for all stages of persistent asthma. However, it is unknown whether ICS dose reduction in adult asthmatics is compatible with maintaining asthma control. Moreover, there are no predictors of efficacy in maintaining asthma control upon ICS reduction. Methods: We recruited 90 adult patients with moderate or severe asthma but no clinical symptoms of asthma for at least 6 months. All patients reduced their ICS doses by half but continued taking other asthma-related medications. As a primary outcome, we measured asthma exacerbations during the 12 months following ICS reduction. We also further monitored patients from the above study who had maintained total asthma control for 12 months after ICS reduction and who had continued on their reduced doses of ICS or had further reduced, or stopped, their ICS. Results: Forty of ninety patients (44.4%) experienced exacerbations after ICS reduction (time to first exacerbation: 6.4±3.6 months). Multivariate logistic regression modeling revealed a rank order of predictors of success in ICS reduction while retaining asthma control: acetylcholine (ACh) PC20 (p<0.01); length of time with no clinical symptoms before ICS reduction (p<0.01); FeNO (p=0.028); and forced expiratory volume in 1 s (FEV1; % predicted) (p=0.03). Finally thirty-nine of 50 patients maintained total asthma control for at least 2 years after the initial ICS reduction. Conclusions: In asthma patients with normalized AChPC20 of 20 mg/mL or 10 mg/mL and no clinical symptoms for at least 12 or 24 months it may be possible to successfully reduce ICS without increasing exacerbations for long time.http://www.sciencedirect.com/science/article/pii/S1323893015302380adult asthmaairway hyperresponsivenessasthma managementICSstep-down |
| spellingShingle | Naomi Tsurikisawa Chiyako Oshikata Takahiro Tsuburai Chihiro Mitsui Hidenori Tanimoto Kentaro Takahashi Kiyoshi Sekiya Takuya Nakazawa Kenji Minoguchi Mamoru Otomo Yuji Maeda Hiroshi Saito Kazuo Akiyama Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics Allergology International adult asthma airway hyperresponsiveness asthma management ICS step-down |
| title | Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics |
| title_full | Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics |
| title_fullStr | Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics |
| title_full_unstemmed | Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics |
| title_short | Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics |
| title_sort | markers for step down of inhaled corticosteroid therapy in adult asthmatics |
| topic | adult asthma airway hyperresponsiveness asthma management ICS step-down |
| url | http://www.sciencedirect.com/science/article/pii/S1323893015302380 |
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