Rapid PublicationsSignificant variability in response to inhaled corticosteroids for persistent asthma☆,☆☆,★
Section snippets
Study population
Study subjects were asthmatic individuals who were 18 to 55 years of age and had a baseline FEV1 of 55% to 85% of predicted, a β2-adrenergic agonist response of ≥12%, an improvement of at least 200 mL in FEV1, a methacholine PC20 value of ≤8 mg/mL, an exercise-induced fall in FEV1 of ≥12%, a morning plasma cortisol value of ≥5 μg/dL, and a smoking history of <10 pack-years; none of the subjects had smoked within the previous year. Subjects were excluded if they had received corticosteroid
Study population
A total of 30 subjects were enrolled (15 in each group); there were no significant differences between the 2 groups at baseline (Table I). Table II presents the results of cohort data with a complete sample set for each parameter. Of the 30 subjects enrolled, 26 completed the study. Of the 4 subjects who stopped participating, 3 withdrew their consent (2 were unwilling to follow the protocol and 1 did not feel the treatment was effective); 1 subject was lost to follow-up.
Cortisol suppression
Overnight plasma
Discussion
This study compared the dose-response effects of 2 ICSs on markers of benefit (FEV1, PC20) and of systemic effect (overnight plasma cortisol) in corticosteroid-naive subjects with persistent asthma. In lieu of more-difficult-to-obtain indicators for significant clinical effects, such as growth, bone density, and cataracts, attention has turned to measures of cortisol suppression as a surrogate marker of systemic effect.14
The 2 ICSs differed in their dose-response profile for both efficacy and
Acknowledgements
We thank Maureen Plourd-Sandoval for assistance with the preparation of this manuscript. Clinical coordinators: J. Burke, RN, E. Freeman, L. Mazzella, C. Connolly, E. Snyder, C. Hong, J. Chang, J. Oliviero (Boston); A. Stevens, J. Derbort, J. Pak (Denver); M. Love-Patton, RN, B. Miller, RN, R. Kelley, R.P.F.T., A. Sexton, MPH (Madison); E. Gilbert, H. Brooks, C. Jimenez, Y. Marcano (New York); P. Ilves-Corressel, RN, C. Czajka, RN, S. Dodds, RN, C. Mitchell, M. Whitsett, D. Campbell, M.
References (24)
Inflammation in asthma: the cornerstone of the disease and target of therapy
J Allergy Clin Immunol
(1998)Effects of inhaled corticosteroids on the consequences of asthma
J Allergy Clin Immunol
(1998)Establishing a therapeutic index for the inhaled corticosteroids: part I. Pharmacokinetic/pharmacodynamic comparison of the inhaled corticosteroids
J Allergy Clin Immunol
(1998)- et al.
Time to onset of effect of fluticasone propionate in patients with asthma
J Allergy Clin Immunol
(1999) - et al.
Rapid onset of control with budesonide Turbuhaler in patients with mild- to-moderate asthma
Ann Allergy Asthma Immunol
(1999) - et al.
Difficult-to-control asthma: clinical characteristics of steroid- insensitive asthma
J Allergy Clin Immunol
(1998) - et al.
Effect of long-term treatment with inhaled corticosteroids and beta-agonists on the bronchial responsiveness in children with asthma
J Allergy Clin Immunol
(1987) - et al.
Non-eosinophilic corticosteroid unresponsive asthma
Lancet
(1999) Global strategy for asthma management and prevention. NHLBI/NIH workshop report. Publication no. 95-3659
(1995)National Asthma Education and Prevention Program expert panel report 2: guidelines for the diagnosis and management of asthma
(1997)
Efficacy and safety of inhaled cortico-steroids. New developments
Am J Respir Crit Care Med
Association of inhaled corticosteroid use with cataract extraction in elderly patients
JAMA
Cited by (561)
The efficacy of citalopram or escitalopram in patients with asthma and major depressive disorder
2024, Annals of Allergy, Asthma and ImmunologyDioscorea nipponica Makino: A comprehensive review of its chemical composition and pharmacology on chronic kidney disease
2023, Biomedicine and PharmacotherapyGEMA 5.3. Spanish Guideline on the Management of Asthma
2023, Open Respiratory ArchivesAsthma exacerbation
2023, Medicine (Spain)Executive summary: Japanese guidelines for adult asthma (JGL) 2021
2023, Allergology InternationalEfficacy and safety of tezepelumab in patients with uncontrolled disease while receiving maintenance therapy for moderate or severe asthma
2023, Journal of Allergy and Clinical Immunology: In Practice
- ☆
Supported by grants U10 HL-51810, U10 HL-51823, U10 HL-51831, U10 HL-51834, U10 HL-51843, U10 HL-51845, and U10 HL-56443 from the National Heart, Lung, and Blood Institute.
- ☆☆
This study was carried out in part in the General Clinical Research Centers at the University of Wisconsin, Brigham and Women's Hospital, Columbia University, and the University of California San Francisco with funds provided by the National Center for Research Resources (5 M01 RR-00079, M01-RR-00645, M01-RR02635, and M01-RR-03186, US Public Health Service).
- ★
Reprint requests: Stanley J. Szefler, MD, National Jewish Medical and Research Center, Department of Pediatrics, Room B104a, 1400 Jackson Street, Denver, CO 80206.