Benefits of low-dose inhaled fluticasone on airway response and inflammation in mild asthma

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• 作者：Louis-Philippe Boulet ; Hé ; lè ; ne Turcotte ; Philippe Prince ; Catherine Lemiè ; re ; Ronald Olivenstein ; Catherine Laprise ; Pierre Larivé ; e ; Paul Bé ; gin ; Michel Laviolette
• 关键词：Mild asthma ; Airway hyperresponsiveness ; Low-dose inhaled corticosteroids ; Methacholine inhalation test ; Induced sputum
• 刊名：Respiratory Medicine
• 出版年：2009
• 出版时间：October 2009
• 年：2009
• 卷：103
• 期：10
• 页码：1554-1563
• 全文大小：346 K

文摘

Summary

Rationale

Current guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required.

Objectives

To evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma.

Methods

In this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250 μg/day for 3 months followed by 100 μg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit.

Results

Fifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC₂₀ methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n = 33) and in fluticasone-treated (n = 24) asthmatic subjects (p = 0.03). An additional improvement in PC₂₀ up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p = 0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250 μg/day compared with placebo (p < 0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups.

Conclusion

In mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range.