Asthma diagnosis and treatment
Inhaled steroids are associated with reduced lung function decline in subjects with asthma with elevated total IgE

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Background

Few studies have investigated the long-term association between inhaled corticosteroids (ICSs) and lung function decline in asthma.

Objective

To evaluate whether prolonged treatment with ICSs is associated with FEV1 decline in adults with asthma.

Methods

An international cohort of 667 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1999 to 2002. Spirometry was performed on both occasions. FEV1 decline was analyzed according to age, sex, height, body mass index, total IgE, time of ICS use, and smoking, while adjusting for potential confounders.

Results

As ICS use increased, the decline in FEV1 was lower (P trend = .025): on average, decline passed from 34 mL/y in nonusers (half of the sample) to 20 mL/y in subjects treated for 48 months or more (18%). When adjusting for all covariates, there was an interaction (P = .02) between ICS use and total IgE: in subjects with high (>100 kU/L) IgE, ICS use for 4 years or more was associated with a lower FEV1 decline (23 mL/y; 95% CI, 8-38 compared with nonusers). This association was not seen in those with lower IgE.

Conclusion

Although confirming a beneficial long-term association between ICSs and lung function in asthma, our study suggests that subjects with high IgE could maximally benefit from a prolonged ICS treatment.

Clinical implications

This study adds further evidence to the beneficial effect of inhaled steroids on lung function in asthma; future studies will clarify whether calibrating the corticosteroid dose according to the level of total IgE is a feasible approach in asthma management.

Section snippets

Study design

The ECRHS is an international multicenter study of asthma. The first survey19 was performed from 1991 to 1993 on random community-based samples of adults age 20 to 44 years. Each participant was sent a brief questionnaire (stage 1) and, from those who responded, a 20% random sample was invited to undergo a more detailed clinical examination (stage 2). In addition, a symptomatic sample consisting of those who reported symptoms of waking with shortness of breath or asthma attacks in the last 12

Comparison between included and excluded subjects

Table I describes the main baseline features of the subjects included and not included in the analysis. The latter are either nonparticipants in the ECRHS II, or participants whose FEV1 was unavailable, not in agreement with the ATS criteria, or measured within 12 hours after the last administration of a LABA. Subjects included in the analysis were slightly older and had a lower percentage of current smokers (30% vs 39%) and of manual workers than subjects who were excluded. On average, among

Discussion

In a large community-based sample of subjects with asthma from the general population, followed up for 9 years, we have shown that a lower decline in FEV1 was associated with a prolonged use of inhaled steroids. This association was only observed in those with elevated total IgE levels. There was a dose-response relationship, with lower decline in those who had used inhaled steroids for the longest periods. The association was found in men and in women, as well as in smokers and in nonsmokers.

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    The coordination of the ECRHS II was supported by the European Commission as part of their Quality of Life program.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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