Atopy Modifies the Association Between Inhaled Corticosteroid Use and Lung Function Decline in Patients with Asthma.

Abstract

BACKGROUND:

Inhaled corticosteroids (ICSs) are the mainstay of asthma treatment, but response to medication is variable. Patients with allergic inflammation generally show a better short-term response to ICSs; however, studies on predictors of long-term response are few.

OBJECTIVE:

To assess whether allergic sensitization can modify the association between ICS use and lung function decline over 20 years in adult asthma.

METHODS:

We used data from the 3 clinical examinations of the European Community Respiratory Health Survey. We measured ICS use (no use, and use for <1.3, 1.3-8, and >8 years) and FEV1 decline among subjects with asthma over the 2 periods between consecutive examinations. We conducted a cohort study combining data of the 2 periods (906 observations from 745 subjects) to assess whether the association between ICS use and FEV1 decline was modified by allergic sensitization (IgE > 0.35 kU/L for any of house-dust mite, timothy grass, cat, or Cladosporium).

RESULTS:

FEV1 decline was similar for non-ICS users, as well as ICS users for less than 1.3 years, with and without allergic sensitization. However, among subjects on ICSs for a longer period, sensitization was associated with an attenuated decline (Pinteraction = .006): in the group treated for more than 8 years, FEV1 decline was on average 27 mL/y (95% CIBonferroni-adjusted, 11-42) lower for subjects with sensitization compared with nonsensitized subjects.

CONCLUSIONS:

Our study suggests that biomarkers of atopy can predict a more favorable long-term response to ICSs. Randomized controlled studies are needed to confirm these findings.

• Authors: Alessandro Marcon, Pierpaolo Marchetti, Josep M Antó, Lucia Cazzoletti, Isa Cerveri, Angelo Corsico, Diogenes Seraphim Ferreira, Judith Garcia-Aymerich, David Gislason, Joachim Heinrich, Rain Jõgi, Ane Johannessen, Bénédicte Leynaert, Andrei Malinovschi, Isabelle Pin, Nicole Probst-Hensch, Joost Weyler, Christer Janson, Deborah Jarvis, Simone Accordini, Ageing Lungs in European Cohorts (ALEC) study
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) Vol. 8 Issue 3 Pg. 980-988.e10 (03 2020) ISSN: 2213-2201 [Electronic] United States
• PMID: 31704441 (Publication Type: Clinical Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenal Cortex Hormones

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Animals
• Asthma (drug therapy, epidemiology)
• Cats
• Cohort Studies
• Humans
• Lung
• Pyroglyphidae