Document Detail


Perception of airway narrowing during reduction of inhaled corticosteroids and asthma exacerbation.
MedLine Citation:
PMID:  14645970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The perception of airway narrowing is reduced in subjects with severe asthma and may be related to the severity of airway inflammation. A study was undertaken to determine if the perception of airway narrowing changes during the reduction of inhaled corticosteroid (ICS) dose or during an asthma exacerbation. METHODS: Forty two asthmatic subjects with well controlled asthma had their daily ICS dose halved every 2 months until they were weaned off ICS or they developed an exacerbation. Perception was measured at baseline and at monthly intervals during bronchial challenge with mannitol as the slope and intercept of the regression of the Borg score and percentage fall in forced expiratory volume in 1 second (FEV(1)), and as the Borg score at 20% fall in FEV(1) (PS(20)FEV(1)). Sputum was collected for measurement of inflammatory cell numbers. RESULTS: In 33 subjects who successfully halved their ICS dose without exacerbation there were significant reductions in slope (p = 0.01), intercept (p = 0.01), and PS(20)FEV(1) (p = 0.003). Sputum eosinophils and airway hyperresponsiveness increased significantly but, in 14 subjects from whom sputum was obtained, changes in eosinophils were not correlated with changes in perception. Change in airway hyperresponsiveness correlated with change in PS(20)FEV(1) (r = -0.40, p = 0.025). In 27 subjects who developed an exacerbation, slope decreased (p = 0.02) and intercept increased (p = 0.01) compared with the visit before the exacerbation. Changes in intercept correlated with changes in resting FEV(1) (r = -0.57, p = 0.002). CONCLUSIONS: Perception of airway narrowing decreases during ICS dose reduction and decreases further during a mild asthma exacerbation. These changes are related to concurrent changes in airway hyperresponsiveness and resting lung function. The effect of changes in airway inflammation on perception is unclear.
Authors:
C M Salome; J D Leuppi; R Freed; G B Marks
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Thorax     Volume:  58     ISSN:  0040-6376     ISO Abbreviation:  Thorax     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-03     Completed Date:  2004-01-06     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  1042-7     Citation Subset:  IM    
Affiliation:
Woolcock Institute of Medical Research (formerly known as Institute of Respiratory Medicine), University of Sydney, NSW 2006, Australia. cms@woolcock.org.au
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Adrenal Cortex Hormones / administration & dosage*
Adult
Asthma / drug therapy*,  physiopathology
Bronchi / drug effects
Bronchial Hyperreactivity / physiopathology
Bronchial Provocation Tests
Bronchitis / etiology,  physiopathology
Dyspnea / etiology,  psychology
Female
Forced Expiratory Volume / drug effects
Humans
Male
Middle Aged
Nitric Oxide / analysis
Perception
Sputum / cytology
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 10102-43-9/Nitric Oxide
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