title: Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program.
abstract: OBJECTIVE
  To assess whether exposure to house dust mite (HDM) allergens hampers a tapering off of inhaled corticosteroid (ICS) dosage in HDM-sensitive asthma patients.
  
  
  METHODS
  Asthma patients sensitised to HDM allergens and using ICS were selected from general practices for this observational study. Dust samples from bed mattresses were taken to assess exposure ('no', 'low', 'intermediate' or 'high') to HDM allergens with a semi-quantitative test (Acarex). Patients were trained to use a self management plan to adjust the dose of ICS according to symptoms and peak flow. The observation period was three months.
  
  
  RESULTS
  Outcomes from 123 patients were analysed. Within the 'no' and 'low' HDM exposure groups the proportion of patients who increased the dosage of their ICS medication was significantly lower than the proportion who tapered off or remained on the same dose of ICS. The group with high exposure to HDM allergens had the highest proportion of patients who increased their dose of ICS (p = 0.055).
  
  
  CONCLUSIONS
  High exposure to HDM allergens seems to coincide with the use of higher dose ICS treatment in asthma patients sensitised to HDM allergens.
authors.affiliation: Department of General Practice, Research Institute Caphri, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. mleindevries@gmail.com
authors.forename: Marjolein P
authors.initials: MP
authors.lastname: de Vries
authors.forename: Lisette
authors.initials: L
authors.lastname: van den Bemt
authors.forename: Bart P A
authors.initials: BP
authors.lastname: Thoonen
authors.forename: Jean W M
authors.initials: JW
authors.lastname: Muris
authors.forename: C P Onno
authors.initials: CP
authors.lastname: van Schayck
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D000485:Allergens / Q000009:adverse effects* / Q000032:analysis; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D011320:Primary Health Care; D039981:Pyroglyphidae; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000485:Allergens