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. 2017 Nov 28;7(11):e018186.
doi: 10.1136/bmjopen-2017-018186.

Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre

Sophie F Demarche  1   2 , Florence N Schleich  1 , Monique A Henket  1 , Virginie A Paulus  1 , Thierry J Van Hees  2 , Renaud E Louis  1
Affiliations

Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre

Sophie F Demarche et al. BMJ Open. .

Abstract

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.

Keywords: adult thoracic medicine; asthma; therapeutics.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Comparison of the effect of an initiation/increased dose of inhaled corticosteroid (ICS) on (A) Asthma Control Questionnaire (ACQ), (B) mini-Asthma Quality of Life Questionnaire (mini-AQLQ), (C) severe exacerbation rate and (D) forced expiratory volume in 1 s (FEV1) in eosinophilic and non-eosinophilic asthmatics. The red and blue horizontal lines represent the mean values in eosinophilic and non-eosinophilic asthmatics, respectively. EA, eosinophilic asthma; NEA, non-eosinophilic asthma.
Figure 2
Figure 2
Comparison of the effect of a cessation/decreased dose of inhaled corticosteroid (ICS) on (A) Asthma Control Questionnaire (ACQ), (B) mini-Asthma Quality of Life Questionnaire (mini-AQLQ), (C) severe exacerbation rate and (D) forced expiratory volume in 1 s (FEV1) in eosinophilic and non-eosinophilic asthmatics. The red and blue horizontal lines represent the mean values in eosinophilic and non-eosinophilic asthmatics, respectively. EA, eosinophilic asthma; NEA, non-eosinophilic asthma.
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