Impact of Inhaled Corticosteroid Treatment on 15-Year Longitudinal Respiratory Function Changes in Adult Patients with Bronchial Asthma

Abstract

Background: Bronchial asthma is mainly controlled by inhaled corticosteroid (ICS) treatment, and discontinuation of ICS treatment can worsen asthma symptoms and reduce respiratory function. However, the longitudinal impact of ICS on lung function in adult patients is unknown. Methods: To determine whether regular ICS treatment can prevent long-term lung function deterioration in adults with bronchial asthma, we recruited 167 adult asthma patients who first visited Fukuoka National Hospital in 1995 and underwent lung function tests in 1995, 1996 and 2010. Regular ICS treatment was continued in 102 patients (regular group), while 39 patients received irregular ICS treatment (irregular group). Changes in lung function were compared retrospectively between the groups. The influences of smoking, disease severity and disease duration were also analyzed. Results: The forced expiratory volume in 1 s (FEV₁) values increased in the regular group 1 year after the initiation of therapy, but they decreased in the irregular group. At year 15, the predicted FEV₁% had decreased significantly more in the irregular group than in the regular group (p < 0.05); FEV₁ decreased by 28.2 ml/year (SD 24.5) in the regular group and by 44.6 ml/year (32.5) in the irregular group (p < 0.05). The decrease in FEV₁ was greater in smokers than in nonsmokers, despite regular ICS treatment, and it was significantly greater in patients with severe asthma than in those with mild or intermittent disease. Delay in ICS initiation also affected the annual FEV₁ decrease. Conclusions: Regular ICS, introduced early when symptoms are mild, could prevent lung function from worsening significantly. Smoking should be strongly discouraged in asthma patients.

The first year of treatment predicts the prognosis of asthma over 25 y—A prospective study

“…The main result is that the mean level of lung function (% of predicted) did not decrease during 25 years. This finding is in agreement with previously published treatment studies, although opposite results also exist . In the study by Shimoda et al, the FEV 1 values improved during the first year of treatment but decreased later on.…”

“…This finding is in agreement with previously published treatment studies, [3][4][5] although opposite results also exist. [6][7][8] In the study by Shimoda et al, 8 in which the FEV 1 level affects the patients' ability to achieve the maintenance control and their perception of their symptoms. 13,40,41 One important finding in our study was that the change in FEV 1 %…”

“…3,4 On the other hand, the results regarding lung function in adult-onset asthma have been inconsistent-there has been either a decline in lung function, no change or even improvement over the years. [5][6][7][8][9][10] Although the long-term prognosis seems to be connected to the asthma phenotypes, 11 there may be other markers for evaluating the prognosis of asthma.…”

A review of the burden and management of mild asthma in adults — Implications for clinical practice

“…In contrast, the START (n=7,241) and OPTIMA (n=1,970) studies monitored large numbers of patients over a longer period and reinforced the benefits of regular ICS in mild asthma [20,21]. prevent lung function from worsening significantly [59]. However, the study was small and the number of participants in each group was unbalanced.…”

The first impression counts for lung function: One year to make a difference in asthma prognosis

“…Conflicting evidence regarding long-term FEV 1 %predicted values in asthma patients has been published. 3,4 However, it is important to emphasize that the majority of patients (59%) had Finally, the importance of taking a holistic view of asthma patients is also highlighted. The association between asthma control, lung function and HR-QoL is not always straightforward, as is known, but has not been evaluated in such long-term basis.…”