Targeting dynamic hyperinflation in moderate-to-severe asthma: a randomised controlled trial

Abstract

BackgroundDynamic hyperinflation (DH) is highly prevalent in moderate to severe asthma, which may significantly impede activities of daily life. We hypothesised that DH in asthma is due to inflammation of large and small airways and can be reduced by systemic anti-inflammatory treatment. Therefore, we investigated the effect of systemic glucocorticoids on DH in moderate to severe asthma patients and explored the relationships between inflammatory markers and changes in DH.MethodsIn this randomised placebo-controlled trial we included 32 asthma patients on inhaled glucocorticoid therapy showing DH, defined by a ≥10% reduction in inspiratory capacity measured by standardised metronome-paced tachypnea test. Patients received either triamcinolone (80 mg) or placebo intramuscularly. Before and 2 weeks after treatment, patients completed respiratory health questionnaires, had blood eosinophils and exhaled nitric oxide levels measured and underwent lung function and DH testing.ResultsAfter adjustment for potential confounders, DH was significantly reduced by 28.1% in the triamcinolone group, and increased by 9.4% in the placebo group (p=0.027). In the triamcinolone-treated patients, the reduction in DH was greater in patients with higher blood eosinophils at baseline (r=−0.592, p=0.020) and tended to be associated with a reduction in blood eosinophils (r=0.412, p=0.127) and exhaled nitric oxide (r=0.442, p=0.099).ConclusionsThis exploratory study suggests that dynamic hyperinflation in asthma can be reduced by systemic anti-inflammatory treatment, particularly in patients with elevated blood eosinophils. This supports the hypothesis that dynamic hyperinflation in asthma is due to airway inflammation and should be considered an important target for treatment.

The Impact of Anti-Eosinophilic Therapy on Exercise Capacity and Inspiratory Muscle Strength in Patients with Severe Asthma

“…The benefits of anti-inflammatory therapy on exercise capacity were previously described by VAN DER MEER et al [9], who analysed the response to corticosteroid treatment in a cohort of moderate-to-severe asthmatic patients. In their study, dynamic hyperinflation was significantly reduced by systemic glucocorticoid therapy, suggesting that anti-inflammatory treatment could improve exercise capacity and quality of life.…”

“…Furthermore, they reported that the administration of bronchodilation therapy prior to cardiopulmonary exercise testing (CPET) did not improve the exercise capacity. A randomised controlled trial was conducted by VAN DER MEER and colleagues [9] to investigate the effect of corticosteroid therapy on dynamic hyperinflation in patients with moderate-to-severe asthma. The authors found that after 2 weeks of triamcinolone therapy the degree of dynamic hyperinflation was reduced by 23.2%.…”

The impact of anti-eosinophilic therapy on exercise capacity and inspiratory muscle strength in patients with severe asthma

“…The benefits of anti-inflammatory therapy on exercise capacity were previously described by V an der M eer et al . [ 9 ], who analysed the response to corticosteroid treatment in a cohort of moderate-to-severe asthmatic patients. In their study, dynamic hyperinflation was significantly reduced by systemic glucocorticoid therapy, suggesting that anti-inflammatory treatment could improve exercise capacity and quality of life.…”

“…Furthermore, they reported that the administration of bronchodilation therapy prior to cardiopulmonary exercise testing (CPET) did not improve the exercise capacity. A randomised controlled trial was conducted by V an der M eer and colleagues [ 9 ] to investigate the effect of corticosteroid therapy on dynamic hyperinflation in patients with moderate-to-severe asthma. The authors found that after 2 weeks of triamcinolone therapy the degree of dynamic hyperinflation was reduced by 23.2%.…”