Protective effect of a low single dose inhaled steroid against exercise induced bronchoconstriction

Visser, Ruurd; Wind, Mariet; Graaf, B. de; Jongh, Franciscus H.C. de; Palen, Job van der; Thio, Boony J.

doi:10.1002/ppul.23144

Cited by 9 publications

(13 citation statements)

References 24 publications

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“…[26][27][28][29][30] This single-dose effect showed a variability similar to the variability observed in longterm treatment. 30 We, therefore, hypothesized that the individual single dose response to ICS could function as a non-invasive predictor for the individual effectiveness of ICS treatment after 4-week treatment. This could be helpful to personalize treatment and prevent inappropriate long-term therapy and/or escalation of therapy.…”

Section: Introductionsupporting

confidence: 60%

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Can the response to a single dose of beclomethasone dipropionate predict the outcome of long‐term treatment in childhood exercise‐induced bronchoconstriction?

Hengeveld

Lammers

Kamp

et al. 2022

Pediatric Allergy Immunology

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Background: Exercise-induced bronchoconstriction (EIB) is a frequent and highly specific symptom of childhood asthma. Inhaled corticosteroids (ICS) are the mainstay of controller therapy for EIB and asthma; however, a proportion of asthmatic children and adolescents is less responsive to ICS. We hypothesized that a single dose response to ICS could function as a predictor for individual long-term efficacy of ICS.Objective: To assess the predictive value of the bronchoprotective effect of a singledose beclomethasone dipropionate (BDP) against EIB for the bronchoprotective effect of 4 weeks of treatment, using an exercise challenge test (ECT).Methods: Thirty-two steroid-naïve children and adolescents aged 6 to 18 years with EIB were included in this prospective cohort study. They performed an ECT at baseline, after a single-dose BDP (200µg) and after 4 weeks of BDP treatment (100 µg twice daily) to assess EIB severity. Results:The response to a single-dose BDP on exercise-induced fall in FEV1 showed a significant correlation with the response on exercise-induced fall in FEV1 after 4 weeks of BDP treatment (r = .38, p = .004). A reduction in post-exercise fall in FEV1 of more than 8% after a single-dose BDP could predict BDP efficacy against EIB after 4 weeks of treatment with a positive predictive value of 100% (CI: 86.1-100%) and a negative predictive value of 29.4% (CI: 11.7%-53.7%). Conclusion:We found that the individual response to a single-dose BDP against EIB has a predictive value for the efficacy of long-term treatment with BDP. This could support clinicians in providing personalized management of EIB in childhood asthma.

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Section: Introductionsupporting

confidence: 60%

“…Previous studies demonstrated a significant acute effect of a single (high and low) dose ICS on bronchial responsiveness measured by an indirect bronchial provocation test 26‐30 . This single‐dose effect showed a variability similar to the variability observed in long‐term treatment 30 .…”

Section: Introductionmentioning

confidence: 60%

Can the response to a single dose of beclomethasone dipropionate predict the outcome of long‐term treatment in childhood exercise‐induced bronchoconstriction?

Hengeveld

Lammers

Kamp

et al. 2022

Pediatric Allergy Immunology

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“…The magnitude of the effect was similar compared to previous studies with a high single dose of ICS. The protective effect against EIB of a low dose BDP inhaled in the standard posture is recently published by our study group [20].…”

Section: Discussionmentioning

confidence: 92%

The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children

Visser

Wind²,

Graaf

et al. 2015

Respiratory Medicine

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“…Besides these chronic effects, previous studies have also shown acute protection against EIB after administration of only a single dose of ICS (43)(44)(45)(46). Visser et al demonstrated a protection ≥50% against EIB in the majority of children (aged 5-16) 4 h after a single low dose of ICS (44).…”

Section: Maintenance Medicationmentioning

confidence: 99%

“…Besides these chronic effects, previous studies have also shown acute protection against EIB after administration of only a single dose of ICS ( 43 – 46 ). Visser et al demonstrated a protection ≥50% against EIB in the majority of children (aged 5–16) 4 h after a single low dose of ICS ( 44 ). In adult asthmatics, acute positive effects on lung function of a single high dose ICS have been shown to last for at least 8 to 9 h ( 47 ).…”

Section: Asthma Medication and Eibmentioning

confidence: 99%

An Algorithm for Strategic Continuation or Restriction of Asthma Medication Prior to Exercise Challenge Testing in Childhood Exercise Induced Bronchoconstriction

et al. 2022

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Exercise induced bronchial (EIB) constriction is a common and highly specific feature of pediatric asthma and should be diagnosed with an exercise challenge test (ECT). The impact of EIB in asthmatic children's daily lives is immense, considering the effects on both physical and psychosocial development. Monitoring childhood asthma by ECT's can provide insight into daily life disease burden and the control of asthma. Current guidelines for bronchoprovocation tests restrict both the use of reliever and maintenance asthma medication before an exercise challenge to prevent false-negative testing, as both have significant acute bronchoprotective properties. However, restricting maintenance medication before an ECT may be less appropiate to evaluate EIB symptoms in daily life when a diagnosis of asthma is well established. Rigorous of maintenance medication before an ECT according to guidelines may lead to overestimation of the real, daily life asthma burden and lead to an inappropiate step-up in therapy. The protection against EIB offered by the combined acute and chronic bronchoprotective effects of maintenance medication can be properly assessed whilst maintaining them. This may aid in achieving the goal of unrestricted participation of children in daily play and sports activities with their peers without escalation of therapy. When considering a step down in medication, a strategic wash-out of maintenance medication before an ECT aids in providing objective support of potential discontinuation of maintenance medication.

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Protective effect of a low single dose inhaled steroid against exercise induced bronchoconstriction

Abstract: A low single dose ICS offers acute protection against EIB in the majority of asthmatic children not currently treated with inhaled corticosteroids.

Cited by 9 publications

References 24 publications

Can the response to a single dose of beclomethasone dipropionate predict the outcome of long‐term treatment in childhood exercise‐induced bronchoconstriction?

Can the response to a single dose of beclomethasone dipropionate predict the outcome of long‐term treatment in childhood exercise‐induced bronchoconstriction?

The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children

An Algorithm for Strategic Continuation or Restriction of Asthma Medication Prior to Exercise Challenge Testing in Childhood Exercise Induced Bronchoconstriction

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