title: Increased periostin associates with greater airflow limitation in patients receiving inhaled corticosteroids.
abstract: BACKGROUND
  Periostin, an extracellular matrix protein, contributes to subepithelial thickening in asthmatic airways, and its serum levels reflect airway eosinophilic inflammation. However, the relationship between periostin and the development of airflow limitation, a functional consequence of airway remodeling, remains unknown.
  
  
  OBJECTIVE
  We aimed to determine the relationship between serum periostin levels and pulmonary function decline in asthmatic patients on inhaled corticosteroid (ICS) treatment.
  
  
  METHODS
  Two hundred twenty-four asthmatic patients (average age, 62.3 years) treated with ICS for at least 4 years were enrolled. Annual changes in FEV1, from at least 1 year after the initiation of ICS treatment to the time of enrollment or later (average, 16.2 measurements over 8 years per individual), were assessed. At enrollment, clinical indices, biomarkers that included serum periostin, and periostin gene polymorphisms were examined. Associations between clinical indices or biomarkers and a decline in FEV1 of 30 mL or greater per year were analyzed.
  
  
  RESULTS
  High serum periostin levels (≥ 95 ng/mL) at enrollment, the highest treatment step, higher ICS daily doses, a history of admission due to asthma exacerbation, comorbid or a history of sinusitis, and ex-smoking were associated with a decline in FEV1 of 30 mL or greater per year. Multivariate analysis showed that high serum periostin, the highest treatment step, and ex-smoking were independent risk factors for the decline. Polymorphisms of periostin gene were related to higher serum periostin levels (rs3829365) and a decline in FEV1 of 30 mL or greater per year (rs9603226).
  
  
  CONCLUSIONS
  Serum periostin appears to be a useful biomarker for the development of airflow limitation in asthmatic patients on ICS.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kanemitsu
authors.forename: Hisako
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Izuhara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tohda
authors.forename: Hideo
authors.initials: H
authors.lastname: Kita
authors.forename: Takahiko
authors.initials: T
authors.lastname: Horiguchi
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Kuwabara
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.forename: Kojiro
authors.initials: K
authors.lastname: Otsuka
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ohkura
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Tomita
authors.forename: Akihito
authors.initials: A
authors.lastname: Yokoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohnishi
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Nakano
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Oguma
authors.forename: Soichiro
authors.initials: S
authors.lastname: Hozawa
authors.forename: Tadao
authors.initials: T
authors.lastname: Nagasaki
authors.forename: Isao
authors.initials: I
authors.lastname: Ito
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Oguma
authors.forename: Hideki
authors.initials: H
authors.lastname: Inoue
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tajiri
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwata
authors.forename: Yumi
authors.initials: Y
authors.lastname: Izuhara
authors.forename: Junya
authors.initials: J
authors.lastname: Ono
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Ohta
authors.forename: Mayumi
authors.initials: M
authors.lastname: Tamari
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Hirota
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Akio
authors.initials: A
authors.lastname: Niimi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D056151:Airway Remodeling / Q000187:drug effects*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology*; D015415:Biomarkers / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000097:blood* / Q000235:genetics; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D012129:Respiratory Function Tests; D015854:Up-Regulation
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D015815:Cell Adhesion Molecules; C512835:POSTN protein, human
keywords: ACT; Asthma; Asthma control test; ECP; Eosinophil cationic protein; FAS I; Fasciclin I; High-sensitivity C-reactive protein; ICS; Inhaled corticosteroids; POSTN gene polymorphism; ROC; Receiver operating characteristic; SNP; Single-nucleotide polymorphism; hsCRP; inhaled corticosteroids; lung function decline; periostin; sinusitis; treatment step