Article (Scientific journals)
Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre
Demarche, Sabine; Schleich, Florence; HENKET, Monique et al.
2017In BMJ Open, 7 (11), p. 018186
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Keywords :
Asthma; Asthma control; Inhaled corticosteroid; Case-Control Studies; Retrospective Studies; Humans; Adult; Male; Female; Forced Expiratory Volume; Eosinophils; Inflammation; Leukocyte Count; Dose-Response Relationship, Drug; Middle Aged; Quality of Life; Respiratory Function Tests; Sputum
Abstract :
[en] OBJECTIVES: The impact of inhaled corticosteroids (ICS) on eosinophilic inflammation in asthma is well established, but their effect in a real-life setting has not been extensively studied. Our purpose was to investigate the effect of ICS on airway and systemic inflammation as well as on clinical outcomes in patients with asthma from clinical practice.DESIGN, SETTING AND PARTICIPANTS: We conducted a retrospective analysis on asthmatics from a secondary care centre in whom ICS were initiated/increased (n=101), stopped/decreased (n=60) or remained stable (n=63, used as a control group) between two visits with available sputum and blood cell counts.RESULTS: The median time between both visits ranged from 1 to 2 years. Initiating or increasing ICS (median variation (IQR): 800 (400-1200) µg beclomethasone equivalent dose per day) reduced sputum eosinophils and fractional exhaled nitric oxide (P<0.0001) and to a lesser extent blood eosinophils (P<0.0001), while withdrawing or decreasing ICS (median variation (IQR): 900 (500-1200) µg beclomethasone equivalentdose per day) resulted in increased sputum eosinophils (P=0.008). No change was found in patients with a stable dose. The effectiveness of ICS in improving asthma control, quality of life, forced expiratory volume in 1 s (FEV1), bronchial hyper-responsiveness and exacerbation rate was only observed in the eosinophilic phenotype (sputum eosinophils ≥3%, n=79). In non-eosinophilic asthmatics, stepping-down ICS resulted in an improvement in asthma control and quality of life, without any significant change in FEV1 (n=38).CONCLUSIONS: Our results confirm the effectiveness of ICS on eosinophilic inflammation in real life and demonstrate that their clinical benefit seems to be restricted to eosinophilic asthmatics. Our data also support a try for stepping-down ICS in non-eosinophilic asthmatics. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Research center :
CIRM - Centre Interdisciplinaire de Recherche sur le Médicament - ULiège
Disciplines :
Cardiovascular & respiratory systems
Pharmacy, pharmacology & toxicology
Author, co-author :
Demarche, Sabine ;  Université de Liège - ULiège > Département de physique > Département de physique
Schleich, Florence ;  Université de Liège - ULiège > Département des sciences de la motricité > Département des sciences de la motricité
HENKET, Monique ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme
PAULUS, Virginie ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Clinique de l'asthme
Van Hees, Thierry ;  Université de Liège - ULiège > Département de pharmacie > Pharmacie clinique et pharmacie hospitalière
Louis, Renaud ;  Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie
Language :
English
Title :
Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre
Publication date :
2017
Journal title :
BMJ Open
eISSN :
2044-6055
Publisher :
BMJ Publishing Group Ltd, London, United Kingdom
Volume :
7
Issue :
11
Pages :
e018186
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 16 September 2018

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