Statin use and asthma control in patients with severe asthma

Abstract

ObjectivesWe hypothesised that severe asthmatics taking a statin drug, in addition to inhaled corticosteroids/long-acting β-agonist inhaler therapy, would have better asthma symptom control and improved lung function compared to their controls.Study designA retrospective, cross-sectional study of 165 patients with severe asthma seen from 2001–2008. Hierarchical linear and logistic regression models were used for modelling fitting.SettingUniversity of California, Davis Medical Center (Sacramento, California, USA). Academic, single-centre, severe asthma subspecialty clinic.Participants612 screened, 223 eligible and 165 adult patients were included in the final study (N=165; 31 statin users and 134 non-users).Primary and secondary outcome measuresThe primary endpoint was asthma control as measured by the Asthma Control Test (ACT). The secondary endpoints included lung function, symptoms and the need for corticosteroid burst and peripheral eosinophil count.ResultsAt baseline, statin users compared to non-users were older, had lower lung function (FEV1% predicted, FEV1, forced vital capacity and FEF25–75%) and had a higher prevalence of comorbid conditions. Statin use was associated with more aspirin and ipratropium inhaler use than in non-users. Patients in both groups were obese (body mass index ≥ 30). Statin users had better asthma symptom control compared to non-users (higher adjusted mean ACT score by 2.2±0.94 points, p<0.02). Median statin use was for 1 year. There were no statistically significant differences in lung function, corticosteroid or rescue bronchodilator use or peripheral eosinophilia between the two groups.ConclusionsIn our severe asthma referral population, statin users already taking inhaled controller therapy achieved better asthma control compared to non-users. The implications of this study is that patients with severe asthma could potentially benefit from added statin treatment. Because our study population was on average obese, the obese severe asthmatic may be a viable asthma subphenotype for further studies. Prospective randomised clinical trials evaluating the safety and efficacy of statins in severe asthma are warranted.

Influence of rosuvastatin treatment on airway inflammatory markers and health related quality of life domains in asthmatic patients

“…Moreover, a recent study has identified higher adjusted mean ACT scores in severe asthmatics with the use of statins [4]. In contrast, these findings were not supported by others [2,17,18].…”

“…Inhibition of airway remodelling which is secondary to airway smooth muscle proliferation and contraction, goblet cell hyperplasia and blockage of inflammatory cell influx with depleted cytokines release are the most significant effects of statins on asthmatic airways [4]. According to Kwak et al, diminished amounts of eosinophils and macrophages after statin treatment are the proof of decreased airway inflammation [3].…”

“…• Medical record of cancer (4) • Chronic obstructive pulmonary disease (4) • Currently usage of statins (7) • History of smoking > 10 pack years (21) 98 patients Figure I: Consort diagram of subjects excluded due to the other exclusion criteria described above. Fifteen individuals refused to provide an informed consent and 8 asthmatics did not come to the final appointment.…”

Asthma Therapy and Its Effect on Airway Remodelling

“…However, a systematic review concluded that although statins had an anti-inflammatory effect in asthma, they did not significantly affect lung function or symptoms [228]. On the other hand, a recent retrospective review of obese patients with severe asthma showed that receiving statins was associated with better symptom control, suggesting a role for statins in this specific asthma phenotype [229]. The effects of statins on inflammation and remodelling have been studied mainly using simvastatin in animal models of allergic asthma.…”

Statins and asthma: where we stand, and the next critical steps in research

“…This work provides indirect evidence that statins may improve important asthma outcomes such as acute exacerbations. This work along with others 2–4 provides support for a large randomized controlled trial (RCT) of a statin intervention in asthma.…”