Changes in airway inflammation and hyperresponsiveness after inhaled corticosteroid cessation in allergic asthma.
BACKGROUND
Most patients with asthma are currently controlled by pharmacotherapeutic means such as inhaled corticosteroid (ICS). However, whether ICS actually induces remission of asthma remains unknown. The present study evaluates changes in airway inflammation and hyperresponsiveness in adult patients with asthma after stopping ICS.


METHODS
We enrolled 11 patients with allergic asthma (7 males and 4 females; mean age, 52.3 years) who had been asymptomatic and had no exacerbation by low-dose ICS. Airway hyperresponsiveness (AHR) was assessed using methacholine challenge, and induced sputum was evaluated before and every 3 months after ICS cessation during the 1-year follow-up.


RESULTS
Among the 11 asthmatics, AHR increased in 10 (90.9%) and asthma clinically relapsed in 4 (36.4%) within 1 year of ICS cessation. AHR increased in all 7 asthmatics that were sensitized to Dermatophagoides farinae and asthma clinically relapsed in 4 (57.1%) of them. Furthermore, eosinophil numbers and IL-4 concentrations in the sputum significantly increased after ICS cessation.


CONCLUSIONS
Remission with normal airway response to methacholine (no AHR) might be rare in adult patients with allergic asthma, and sensitization to house dust mites appears to play an important role in relapse. Therefore, ICS cessation should be carefully considered in patients sensitive to house dust mites. Serial determination of eosinophil counts or IL-4 concentrations in sputum might be appropriate for monitoring and preventing asthma relapse in adults.
Department of Respiratory Medicine, Allergy Center, Saitama Medical University, Saitama, Japan.
Yotaro
Y
Takaku
Kazuyuki
K
Nakagome
Takehito
T
Kobayashi
Takefumi
T
Yamaguchi
Fuyumi
F
Nishihara
Tomoyuki
T
Soma
Koichi
K
Hagiwara
Minoru
M
Kanazawa
Makoto
M
Nagata
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D039741:Antigens, Dermatophagoides / Q000276:immunology; D001249:Asthma / Q000188:drug therapy / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology*; D016535:Bronchial Hyperreactivity / Q000503:physiopathology*; D004804:Eosinophils / Q000166:cytology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007249:Inflammation / Q000378:metabolism / Q000473:pathology; D007371:Interferon-gamma / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013183:Sputum / Q000166:cytology / Q000378:metabolism; D028761:Withholding Treatment
D000305:Adrenal Cortex Hormones; D039741:Antigens, Dermatophagoides; C508598:IL4 protein, human; D015847:Interleukin-4; D007073:Immunoglobulin E; D007371:Interferon-gamma