Low-Dose Inhaled Corticosteroids and the Prevention of Death from Asthma

Suissa, Samy; Ernst, Pierre; Benayoun, Serge; Baltzan, Marc; Cai, Bing

doi:10.1056/nejm200008033430504

Cited by 1,010 publications

(483 citation statements)

References 24 publications

Supporting

Mentioning

446

Contrasting

Unclassified

Order By: Relevance

“…It has been reported that the regular use of ICS and a good compliance is associated with a decreased risk of death and hospitalization owing to asthma [21, 22], as well as with fewer asthma attacks [23]. In our multivariate analysis, the regular use of medication and the self-reported compliance were positively associated with the absence of asthma attacks, even if the association was not statistically significant and the strength of the association was definitely lower than that related to an adequate dosage of anti-inflammatory drugs.…”

Section: Discussionmentioning

confidence: 99%

Are the Asthma Guideline Goals Achieved in Daily Practice? A Population-Based Study on Treatment Adequacy and the Control of Asthma

Marco

Cazzoletti

Cerveri

et al. 2005

Int Arch Allergy Immunol

View full text Add to dashboard Cite

Background: The guidelines for asthma recommend that the use of anti-inflammatory therapy should be adapted to the severity of the disease. However, few data are available to assess the adequacy of the use of drugs and its influence on the control of asthma in ‘real life’. Methods: The adequacy of the current use of anti-asthmatic medication according to the Global Initiative for Asthma (GINA) guidelines was assessed in a random sample of 400 asthmatics identified in the frame of the Italian Study on Asthma in Young Adults. Asthma severity was assessed using the GINA criteria; accordingly, a patient was classified as receiving inadequate treatment if his/her current use of drugs was lower than that suggested by the guidelines for the corresponding severity level. The absence of asthma attacks in the last 3 months was used as an indicator of the disease control. Results: Fifty-five percent of the patients had persistent asthma. Overall, 48% (95% CI 41.2–54.8) of persistent asthmatics were receiving inadequate treatment, and 66% (95% CI 59.5–72.4) had not used their medication daily over the past 3 months. Persistent asthmatics who were inadequately treated had a significantly greater frequency of asthma attacks (geometric mean ratio 3.7; 95% CI 2.1–6.6) than those using an adequate dose of medication. Mild and moderate persistent asthmatics using an adequate medication regimen reported a low number of asthma attacks (median 0). At the multivariate analysis, a good control of the disease was positively associated with an adequate dose of anti-inflammatory medication (OR = 2.2; 95% CI 1.1–4.5) and was negatively associated with a later onset of asthma (OR = 0.96; 95% CI 0.93–0.99) and severe asthma (OR = 0.37; 95% CI 0.17–0.81). Conclusions: Despite the increase in the use of inhaled corticosteroids, half of the persistent asthmatics from the general population are using a medication regimen below their severity level. When the use of drugs follows the GINA guideline recommendations, a good control of asthma is also achievable in the daily management of the disease, particularly in the case of mild and moderate asthmatics.

show abstract

Section: Discussionmentioning

confidence: 99%

Are the Asthma Guideline Goals Achieved in Daily Practice? A Population-Based Study on Treatment Adequacy and the Control of Asthma

Marco

Cazzoletti

Cerveri

et al. 2005

Int Arch Allergy Immunol

View full text Add to dashboard Cite

show abstract

“…The commencement of ICS treatment at a very early stage of asthma can reduce the risk of a later decline in lung function [4]. Regular ICS treatment is effective in preventing the worsening of symptoms, asthma-related deaths and hospitalization; this efficacy is long lasting [5,6]. A long-term study of adult asthma, which lasted 15 years, from 1976 to 1994 (a period before the widespread use of ICS treatment), showed that the forced expiratory volume (FEV) decreased by 38 ml/year in asthmatics and by 22 ml/year in non-asthmatics [7].…”

Section: Introductionmentioning

confidence: 99%

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

Shimoda

Obase²,

Kishikawa³

et al. 2013

Int Arch Allergy Immunol

View full text Add to dashboard Cite

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.

show abstract

“…For example, in a large community study, the risk of dying of asthma was lower for patients who were dispensed four or more low-dose corticosteroid inhalers per year compared with those who received none. 7 In a large randomised controlled trial, the risk of serious exacerbations (emergency department visits, hospitalisations, death) was also halved and symptoms were significantly reduced with regular use of budesonide 400 micrograms/day, even in patients with symptoms as infrequent as once a week or less.…”

Section: Inhaled Corticosteroids Are Very Effectivelow Dose and Afformentioning

confidence: 99%

The cost of asthma medicines

2018

View full text Add to dashboard Cite

Low-Dose Inhaled Corticosteroids and the Prevention of Death from Asthma

Abstract: The regular use of low-dose inhaled corticosteroids is associated with a decreased risk of death from asthma.

Cited by 1,010 publications

References 24 publications

Are the Asthma Guideline Goals Achieved in Daily Practice? A Population-Based Study on Treatment Adequacy and the Control of Asthma

Are the Asthma Guideline Goals Achieved in Daily Practice? A Population-Based Study on Treatment Adequacy and the Control of Asthma

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

The cost of asthma medicines

Contact Info

Product

Resources

About