Objectives The impact of inhaled corticosteroids (ICS) on eosinophilic inflammation in asthma is well established, but their effect in a real-life setting has not been extensively studied. Our purpose was to investigate the effect of ICS on airway and systemic inflammation as well as on clinical outcomes in patients with asthma from clinical practice.
Design, setting and participants We conducted a retrospective analysis on asthmatics from a secondary care centre in whom ICS were initiated/increased (n=101), stopped/decreased (n=60) or remained stable (n=63, used as a control group) between two visits with available sputum and blood cell counts.
Results The median time between both visits ranged from 1 to 2 years. Initiating or increasing ICS (median variation (IQR): 800 (400–1200) µg beclomethasone equivalent dose per day) reduced sputum eosinophils and fractional exhaled nitric oxide (P<0.0001) and to a lesser extent blood eosinophils (P<0.0001), while withdrawing or decreasing ICS (median variation (IQR): 900 (500–1200) µg beclomethasone equivalentdose per day) resulted in increased sputum eosinophils (P=0.008). No change was found in patients with a stable dose. The effectiveness of ICS in improving asthma control, quality of life, forced expiratory volume in 1 s (FEV1), bronchial hyper-responsiveness and exacerbation rate was only observed in the eosinophilic phenotype (sputum eosinophils ≥3%, n=79). In non-eosinophilic asthmatics, stepping-down ICS resulted in an improvement in asthma control and quality of life, without any significant change in FEV1 (n=38).
Conclusions Our results confirm the effectiveness of ICS on eosinophilic inflammation in real life and demonstrate that their clinical benefit seems to be restricted to eosinophilic asthmatics. Our data also support a try for stepping-down ICS in non-eosinophilic asthmatics.
- adult thoracic medicine
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Contributors SFD and REL were involved in the conception and design of the study. SFD, FNS, VAP, MAH and REL collected the patients’ data. SFD performed the statistical analysis. SFD, REL and TVH interpreted the data. SFD and REL drafted the manuscript. FNS, VAP, MAH and TVH revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Funding This work was supported by a federal grant IAP (’Interuniversity Attraction Poles' programme) P7/30.
Competing interests TVH received grants from Amgen, outside the submitted work. REL received grants and personal fees from GSK, Chiesi, Astra Zeneca, Novartis, outside the submitted work.
Ethics approval Ethics Committee of the University Hospital of Liege approved this study (reference 2017/97).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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