Chest
Clinical Investigations: AsthmaIs Normal Bronchial Responsiveness in Asthmatics a Reliable Index for Withdrawing Inhaled Corticosteroid Treatment
Section snippets
Subjects
Our study included 18 subjects with mild persistent asthma1 (11 men), attending the outpatient clinic at the Occupational Medicine and Toxicology Section, University of Perugia, Perugia, Italy. At diagnosis, all subjects had BHR or reversible airflow obstruction, and persistent mild symptoms of asthma. Nine subjects were atopic. Atopy was defined as the presence of a positive skin test reaction to one or more common aeroallergens.6 Each subject was in stable condition and had not received oral
RESULTS
Four subjects with NBR and six subjects with BHR experienced asthma exacerbation after ICS treatment withdrawal, a frequency similar in the two groups (60.0% vs 50.0%) (p=0.914) (Table 2). During the study, none of the subjects were exposed to any allergen to which they were sensitive or had symptoms of respiratory tract infections.
Subjects with NBR tended to remain asymptomatic after ICS treatment withdrawal for a longer period than those with BHR (10.7±4.4 days vs 5.5±3.8 days) (mean±SD)
DISCUSSION
Our study shows that the normalization of BHR is not a reliable index assessing the opportunity of ICS treatment withdrawal in asthmatic subjects.
The increasing use of ICS in asthma treatment (with its risk of adverse effects and its cost) has indicated that an objective parameter of asthma severity is needed for correct management of therapy. In particular, the opportunity of ICS treatment withdrawal needs to be assessed objectively. Therefore, since it is an important determinant of the
ACKNOWLEDGMENT
The authors thank Dr. G. A. Boyd for her help in reviewing this article and Stefania Rometta for her secretarial assistance.
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Cited by (12)
Variability of methacholine bronchoprovocation and the effect of inhaled corticosteroids in mild asthma
2014, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :This may be due to an insufficient duration for the treatment and/or the washout period. A washout time of 4 weeks for ICS was chosen based on studies reporting exacerbations occurring after this period (indicating disappearance of treatment effect).21,22 Nevertheless, a differential effect was observed due to the ordering of doses.
Down-titration from high-dose combination therapy in asthma: Removal of long-acting β<inf>2</inf>-agonist
2010, Respiratory MedicineCitation Excerpt :These factors may limit the applicability of the freezing technique for future studies. Previous studies indicate that AHR reflects an important aspect of asthma control,38 and predicts exacerbations,43,44 loss of control with ICS reduction,6 and shorter time to exacerbation after ICS withdrawal.45 In the present study, baseline PD20 was the only significant predictor of mean daily ICS dose during down-titration.
Overdiagnosis of asthma in obese and nonobese adults
2008, CMAJ. Canadian Medical Association Journal
Supported by a grant from MURST (40%).
Presented in part at the European Respiratory Society Annual Congress, Nice, France, October 1994.