Inhaled corticosteroids and decline of lung function in community residents with asthma

Abstract

Background: Inhaled corticosteroids (ICS) constitute the cornerstone of treatment for asthma. Many studies have reported beneficial short term effects of these drugs, but there are few data on the long term effects of ICS on the decline in forced expiratory volume in 1 second (FEV 1 ). This study was undertaken to determine whether adults with asthma treated with ICS have a less pronounced decline in FEV 1 than those not treated with ICS. Methods: Two hundred and thirty four asthmatic individuals from a longitudinal epidemiological study of the general population of Copenhagen, Denmark were divided into two groups; 44 were treated with ICS and 190 were not treated with ICS. The annual decline in FEV 1 was measured over a 10 year follow up period. Results: The decline in FEV 1 in the 44 patients receiving ICS was 25 ml/year compared with 51 ml/year in the 190 patients not receiving this treatment (p,0.001). The linear regression model with ICS as the variable of interest and sex, smoking, and wheezing as covariates showed that treatment with ICS was associated with a less steep decline in FEV 1 of 18 ml/year (p = 0.01). Adjustment for additional variables including age, socioeconomic status, body mass index, mucus hypersecretion, and use of other asthma medications did not change these results. Conclusions: Treatment with ICS is associated with a significantly reduced decline in ventilatory function.

Smoking and Asthma

“…87 In contrast, a 10-year observational study of 234 asthmatic patients reported that smokers experienced significant improvement in FEV 1 after treatment with ICS (57.9 mL/year vs 30.8 mL/year; P ϭ .035). 88 In addition, a post hoc analysis of the Inhaled Steroid Treatment as Regular Therapy Trial by O'Byrne and colleagues 89 reported that patients with newly diagnosed mild asthma who smoked did show significant improvements in post bronchodilater FEV1 measurements after 3 years of treatment with inhaled budesonide 400 g daily (71.5 mL in smokers [P ϭ .011] vs 46.5 mL in nonsmokers [P ϭ .001]). More studies are needed to fully elucidate the effects of smoking on lung function decline among asthmatic smokers.…”

Co-morbidity of bronchial asthma and chronic obstructive pulmonary disease

“…Таким образом, тем пы снижения ОФВ 1 у таких больных вполне сопоста вимы с темпами ухудшения показателей спиромет рии у больных ХОБЛ (31 % больных ХОБЛ теряют ежегодно от 20 до 30 мл ОФВ 1, а еще 31 % больных -< 20 мл / год) [18]. Скорость снижения ОФВ1 у па циентов с БА пропорциональна интенсивности ку рения и выше у молодых [19].…”

Current opinion: Pharmacological approaches in asthma and COPD

“…Intriguingly, it has been reported that regularly scheduled treatment with an ICS for mild persistent asthma has no signifi cant advantage over intermittent short-course treatment [52]. In any case, two observational studies suggest that longterm treatment with an ICS in asthmatic adults is associated with a more favourable decline in FEV1 with age compared with the natural course of the disease [53,54]. The use of ICSs on a regular basis also leads to reduced mortality from asthma.…”