Comparison of Physician-, Biomarker-, and Symptom-Based Strategies for Adjustment of Inhaled Corticosteroid Therapy in Adults With Asthma

Abstract

STHMA IS MANAGED BY CONsensus guidelines. 1,2 Disease activity varies daily, seasonally, and episodically, presumably related to airway inflammation. 3 Accordingly, asthma management requires periodic dose adjustments of controller medications, particularly inhaled corticosteroids. Adjustments have been based on (1) physician assessment of symp-For editorial comment see p 1036.

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

“…99 Four other studies also suggested no or weak association of FeNO and ACT in ICS users. [100][101][102][103] In children with atopic asthma, FeNO was significantly elevated in those with exercise induced reduction of FEV 1 (> 15%) with a negative predictive value (NPV) of 100% and a positive predictive value (PPV) of 28%. NPV and PPV for reported asthma symptoms within 2 weeks preceding the study were 96% and 26%.…”

Inhaled corticosteroid dose response in asthma

“…Mann PD 10 Provocative dose of mannitol causing a 10% fall in FEV 1 44 Mann PD 15 Provocative dose of mannitol causing a 15% fall in FEV 1 45 …”

“…However, other studies have suggested a more 31 muted response to inflammatory steroid titration in unselected asthmatic 32 patients 14,15 . 33 34 Price et al demonstrated retrospectively, in a primary care cohort, that 35 asthmatic patients with higher blood eosinophil counts fared worse in terms of 36 experiencing more severe exacerbations and poorer asthma control 16 .…”

Early Prescription of Inhalation Corticosteroid in Bronchial Asthma

“…В другом исследовании, прове-денном среди пациентов с легким и среднетяжелым течением БА, было продемонстрировано, что время, в течение которого была отмечена неэффективность тера-пии, было примерно одинаковым и при назначении БДП и сальбутамола по потребности (в разных ингаляторах), и поддерживающей дозы ИКС, доза которых корректи-ровалась через 6-недельные интервалы в зависимости от решения врача [51]. В похожем исследовании, в кото-ром использовались отдельные ингаляторы для ИКС и КДБА для симптоматической терапии и регулярной терапии у детей [52], был показан сопоставимый уро-вень риска отсутствия эффективности терапии по срав-нению с регулярной терапией фиксированными дозами ИКС.…”