Clinical studyEffect of short-term treatment with inhaled corticosteroid on airway wall thickening in asthma
Section snippets
Subjects
Fifty-one patients with persistent asthma and 28 healthy controls were recruited. All patients fulfilled the American Thoracic Society criteria for asthma (24), and none had ever received systemic or inhaled corticosteroids, cromones, or antileukotriene agents or had acute exacerbations of asthma during the previous 8 weeks. The severity of asthma was classified according to an international guideline (23). None of the subjects had ever smoked cigarettes, and none had a respiratory tract
Results
Six of the 51 enrolled patients were excluded: 2 had exacerbations of asthma requiring medication, 2 had respiratory tract infections at follow-up examinations, 1 refused repeated CT scanning, and 1 was lost to follow-up. In the 45 patients who completed the study, the mean duration of asthma was 7.3 ± 10.5 years (median, 3.4 years; interquartile range, 1.0 to 10.0 years). The asthma was mild in 9 patients, moderate in 25, and severe in 11.
There were no differences in age, sex, or body surface
Discussion
This study shows that treatment with moderate doses of inhaled corticosteroid for 12 weeks reduced airway wall thickness, as assessed by CT scans, modestly but significantly in patients with persistent asthma. However, airway wall thickness remained significantly greater than in controls.
The components of airway wall thickening that responded to treatment may have included inflammatory factors, since the decrease in wall thickness/body surface area correlated with a decrease in serum eosinophil
Acknowledgements
We thank Ryuzo Tanaka, Hiroyuki Akazawa, Noboru Narai, and Miho Morimoto for radiological and technical support, and Mafumi Kurozumi for handling the serum for measurement of eosinophil cationic protein.
References (41)
- et al.
Inhaled corticosteroids decrease subepithelial collagen deposition by modulation of the balance between matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 expression in asthma
J Allergy Clin Immunol
(1999) - et al.
Dose-response evaluation of the therapeutic index for inhaled budesonide in patients with mild-to-moderate asthma
Am J Med
(2000) - et al.
Interferon therapy induces the improvement of lung function by inhaled corticosteroid therapy in asthmatic patients with chronic hepatitis C virus infection. A preliminary study
Chest
(2003) - et al.
The mechanics in airway narrowing in asthma
Am Rev Respir Dis
(1989) - et al.
Small airways dimensions in asthma and chronic obstructive pulmonary disease
Am Rev Respir Dis
(1993) - et al.
The structure of large and small airways in nonfatal and fatal asthma
Am Rev Respir Dis
(1993) - et al.
Airway wall thickening
Remodeling in asthma and chronic obstructive lung disease
Am J Respir Crit Care Med
(2001)- et al.
Pharmacotherapy and airway remodelling in asthma?
Thorax
(2003) - et al.
A model of the mechanics of airway narrowing
J Appl Physiol
(1990)