Effect of early versus late intervention with inhaled  corticosteroids on airway wall thickness in patients with asthma.
OBJECTIVE
The aim of this study was to determine whether early versus late initiation of long-term inhaled corticosteroid (ICS) therapy decreases airway wall thickness in patients with asthma.


METHODS
One hundred and eighty-one patients with asthma not previously treated with ICS were given inhaled budesonide for 1 year. These patients were divided into five groups according to the duration of their asthma symptoms, which ranged from less than 1 year to more than 10 years. High-resolution CT images and post-bronchodilator FEV1 were examined before and 1 year after treatment.


RESULTS
Before treatment, airway wall thickness was increased relative to the duration of asthma. Disease severity improved with ICS treatment even in patients who had suffered asthma symptoms for more than 10 years. Post ICS treatment, airway wall thickness decreased in patients with a duration of symptoms less than 3 years, and a minor response was seen in patients with a duration of symptoms from 3 to 5 years. However, there was no change in airway wall thickness in patients who had suffered asthma for more than 5 years. Post-bronchodilator FEV1 improved only in patients who had suffered asthma for less than 3 years.


CONCLUSIONS
ICS therapy may improve asthma control in all asthma patients despite the disease duration, but early ICS treatment may be critical to reverse airway wall thickening associated with asthma.
Kurashima
Kazuyoshi
K
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan. a1091749@pref.saitama.jp
Kanauchi
Tetsu
T
Hoshi
Toshiko
T
Takaku
Yotaro
Y
Ishiguro
Takashi
T
Takayanagi
Noboru
N
Ubukata
Mikio
M
Sugita
Yutaka
Y
D000280:Administration, Inhalation; D001249:Asthma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019819:Budesonide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D005938:Glucocorticoids; D019819:Budesonide