Markers for Step-Down of Inhaled Corticosteroid Therapy in Adult Asthmatics

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 mai...

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Bibliographic Details
Published in:Allergology International 2012, Vol.61 (3), p.419-429
Main Authors: Tsurikisawa, Naomi, Oshikata, Chiyako, Tsuburai, Takahiro, Mitsui, Chihiro, Tanimoto, Hidenori, Takahashi, Kentaro, Sekiya, Kiyoshi, Nakazawa, Takuya, Minoguchi, Kenji, Otomo, Mamoru, Maeda, Yuji, Saito, Hiroshi, Akiyama, Kazuo
Format: Article
Language:English
Subjects:
Administration, Inhalation
Adrenal Cortex Hormones - administration & dosage
Adult
adult asthma
Aged
airway hyperresponsiveness
Anti-Asthmatic Agents - administration & dosage
Asthma - diagnosis
Asthma - drug therapy
asthma management
Biomarkers
Bronchial Provocation Tests
Female
Humans
ICS
Male
Middle Aged
Nebulizers and Vaporizers
Nitric Oxide
Prognosis
Prospective Studies
step-down
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Summary: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. 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. 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
ISSN:1323-8930
1440-1592
DOI:10.2332/allergolint.11-OA-0402