Effect of Early vs Late Intervention With Inhaled Corticosteroids in Asthma

Selroos, Olof; Pietinalho, Anne; Löfroos, A B; Riska, Henrik

doi:10.1378/chest.108.5.1228

Cited by 351 publications

(181 citation statements)

References 12 publications

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“…The same result was found in another "open" study (106) in 105 patients with mild to moderate asthma not earlier treated with inhaled corticosteroids, but needing an inhaled bronchodilator of three or more doses a week and/or having asthma symptoms. These asthmatics were treated with an inhaled corticosteroid for 2 years.…”

Section: Therapysupporting

confidence: 79%

“…The observation that active smoking during adolescence is associated with shortening of the plateau phase of FEV, that generally occurs between 20 and 35 years of age (101) suggests that there is an overall negative effect of smoking in adolescence which may also be present in asthmatic subjects. Further observations have shown that cessation of smoking during adolescence had a positive impact on lung growth (106).…”

Section: Smokingmentioning

confidence: 95%

See 1 more Smart Citation

Asthma: from childhood to adulthood

Grol¹,

Gerritsen²,

Postma

1996

Allergy

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Section: Therapysupporting

confidence: 79%

Section: Smokingmentioning

confidence: 95%

Asthma: from childhood to adulthood

Grol¹,

Gerritsen²,

Postma

1996

Allergy

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“…Subjects were selected for poor asthma control at baseline, and came from a community rather than a clinic population. They were chronically undertreated on entry and thus obviously had the potential for substantial improvement; however, most (87%) of the subjects had had asthma for >10 yrs, a feature previously associated with relatively poor response to inhaled corticosteroids [33].…”

Section: Discussionmentioning

confidence: 99%

Optimal asthma control, starting with high doses of inhaled budesonide

et al. 2000

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The aim of this study was to determine whether outcomes in poorly controlled asthma can be further improved with a starting dose of inhaled budesonide higher than that recommended in international guidelines.The study had a parallel-group design and included 61 subjects with poorly controlled asthma, randomized to receive 3,200 mg or 1,600 mg budesonide daily by Turbuhaler1 for 8 weeks (double-blind), then 1,600 mg . day -1 for 8 weeks (single-blind), followed by 14 months of open-label budesonide dose down-titration using a novel algorithm, with a written asthma crisis plan based on electronic peak expiratory flow monitoring. The primary outcome variable for weeks 1±16 was change in airway hyperresponsiveness (AHR), and, for the open-label phase, mean daily budesonide dose.By week 16, there were large changes from baseline in all outcomes, with no significant differences between the 3,200-and 1,600-mg . day -1 starting dose groups (AHR increased by 3.2 versus 3.0 doubling doses, p=0.7; morning peak flow increased by 134 versus 127 L . min -1 , p=0.8). Subjects starting with 3,200 mg . day -1 were 3.8 times more likely to achieve AHR within the normal range, as defined by a provocative dose of histamine causing a 20% fall in forced expiratory volume in one second (PD20) of $3.92 mmol by week 16 (p=0.03). During dose titration, there was no significant difference in mean budesonide dose (1,327 versus 1,325 mg . day -1 , p>0.3). Optimal asthma control was achieved in the majority of subjects (at completion/withdrawal: median symptoms 0.0 days . week -1 , b 2 -agonist use 0.2 occasions . day -1 , and PD20 2.4 mmol).In subjects with poorly controlled asthma, a starting dose of 1,600 mg . day -1 budesonide was sufficient to lead to optimal control in most subjects. The high degree of control achieved, compared with previous studies, warrants further investigation. Eur Respir J 2000; 15: 226±235.

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“…Airway remodelling has been considered to be an irreversible process, although there is evidence to suggest that early use of corticosteroids can delay or even reverse the structural changes [46]. A 5-yr follow-up study comparing subjects treated with corticosteroid early in the course of their disease to a delayed treatment group showed that early use of corticosteroids (budesonide) significantly improved lung function and increased exercise tolerance.…”

Section: Reversibility Of Remodelling?mentioning

confidence: 99%

The contribution of transforming growth factor- and epidermal growth factor signalling to airway remodelling in chronic asthma

Boxall

Holgate²,

Davies³

2006

European Respiratory Journal

225

187

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Asthma is increasing in prevalence in the developing world, affecting ,10% of the world's population. It is characterised by chronic lung inflammation and airway remodelling associated with wheezing, shortness of breath, acute bronchial hyperresponsiveness to a variety of innocuous stimuli and a more rapid decline in lung function over time.Airway remodelling, involving proliferation and differentiation of mesenchymal cells, particularly myofibroblasts and smooth muscle cells, is generally refractory to corticosteroids and makes a major contribution to disease chronicity. Transforming growth factor-b is a potent profibrogenic factor whose expression is increased in the asthmatic airways and is a prime candidate for the initiation and persistence of airway remodelling in asthma.This review highlights the role of transforming growth factor-b in the asthmatic lung, incorporating biosynthesis, signalling pathways and functional outcome. In vivo, however, it is the balance between transforming growth factor-b and other growth factors, such as epidermal growth factor, which will determine the extent of fibrosis in the airways.A fuller comprehension of the actions of transforming growth factor-b, and its interaction with other signalling pathways, such as the epidermal growth factor receptor signalling cascade, may enable development of therapies that control airway remodelling where there is an unmet clinical need.

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Effect of Early vs Late Intervention With Inhaled Corticosteroids in Asthma

Cited by 351 publications

References 12 publications

Asthma: from childhood to adulthood

Asthma: from childhood to adulthood

Optimal asthma control, starting with high doses of inhaled budesonide

The contribution of transforming growth factor- and epidermal growth factor signalling to airway remodelling in chronic asthma

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