TY - JOUR
T1 - Inhaled steroids are associated with reduced lung function decline in subjects with asthma with elevated total IgE
AU - de Marco, Roberto
AU - Marcon, Alessandro
AU - Jarvis, Deborah
AU - Accordini, Simone
AU - Bugiani, Massimiliano
AU - Cazzoletti, Lucia
AU - Cerveri, Isa
AU - Corsico, Angelo
AU - Gislason, David
AU - Gulsvik, Amund
AU - Jõgi, Rain
AU - Martínez-Moratalla, Jesús
AU - Pin, Isabelle
AU - Janson, Christer
N1 - Funding Information:
The coordination of the ECRHS II was supported by the European Commission as part of their Quality of Life program.
PY - 2007/3
Y1 - 2007/3
N2 - 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.
AB - 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.
KW - Asthma
KW - ECRHS
KW - European Community Respiratory Health Survey
KW - FEV decline
KW - eosinophils
KW - inhaled corticosteroids
KW - lung function decline
KW - prospective cohort study
KW - total IgE
UR - http://www.scopus.com/inward/record.url?scp=33847246296&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2006.11.696
DO - 10.1016/j.jaci.2006.11.696
M3 - Article
C2 - 17258304
AN - SCOPUS:33847246296
SN - 0091-6749
VL - 119
SP - 611
EP - 617
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 3
ER -