title: Inhaled steroids are associated with reduced lung function decline in subjects with asthma with elevated total IgE.
abstract: BACKGROUND
  Few studies have investigated the long-term association between inhaled corticosteroids (ICSs) and lung function decline in asthma.
  
  
  OBJECTIVE
  To evaluate whether prolonged treatment with ICSs is associated with FEV(1) decline in adults with asthma.
  
  
  METHODS
  An international cohort of 667 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1999 to 2002. Spirometry was performed on both occasions. FEV(1) decline was analyzed according to age, sex, height, body mass index, total IgE, time of ICS use, and smoking, while adjusting for potential confounders.
  
  
  RESULTS
  As ICS use increased, the decline in FEV(1) was lower (P trend = .025): on average, decline passed from 34 mL/y in nonusers (half of the sample) to 20 mL/y in subjects treated for 48 months or more (18%). When adjusting for all covariates, there was an interaction (P = .02) between ICS use and total IgE: in subjects with high (>100 kU/L) IgE, ICS use for 4 years or more was associated with a lower FEV(1) decline (23 mL/y; 95% CI, 8-38 compared with nonusers). This association was not seen in those with lower IgE.
  
  
  CONCLUSIONS
  Although confirming a beneficial long-term association between ICSs and lung function in asthma, our study suggests that subjects with high IgE could maximally benefit from a prolonged ICS treatment.
  
  
  CONCLUSIONS
  This study adds further evidence to the beneficial effect of inhaled steroids on lung function in asthma; future studies will clarify whether calibrating the corticosteroid dose according to the level of total IgE is a feasible approach in asthma management.
authors.affiliation: University of Verona, Department of Medicine and Public Health, Unit of Epidemiology and Medical Statistics, Verona, Italy. roberto.demarco@univr.it
authors.forename: Roberto
authors.initials: R
authors.lastname: de Marco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marcon
authors.forename: Deborah
authors.initials: D
authors.lastname: Jarvis
authors.forename: Simone
authors.initials: S
authors.lastname: Accordini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Bugiani
authors.forename: Lucia
authors.initials: L
authors.lastname: Cazzoletti
authors.forename: Isa
authors.initials: I
authors.lastname: Cerveri
authors.forename: Angelo
authors.initials: A
authors.lastname: Corsico
authors.forename: David
authors.initials: D
authors.lastname: Gislason
authors.forename: Amund
authors.initials: A
authors.lastname: Gulsvik
authors.forename: Rain
authors.initials: R
authors.lastname: Jõgi
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez-Moratalla
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pin
authors.forename: Christer
authors.initials: C
authors.lastname: Janson
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D002000:Bronchospirometry; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male
chemical_list: D000305:Adrenal Cortex Hormones; D007073:Immunoglobulin E