Can Inhaled Corticosteroids Prevent Asthma Exacerbations?

Dhananjay Desai; Salman Siddiqui; Christopher Brightling

Disclosures

Curr Opin Pulm Med. 2011;17(1):16-22. 

In This Article

Asthma Exacerbations: Impact upon Disease Progression

It is recognized that a subset of asthmatic patients will experience an accelerated decline in FEV1;[64] this effect is possibly amplified by frequent exacerbations – as patients who experience exacerbations are likely to develop severe fixed airway obstruction,[65] which in itself is a risk factor for more exacerbations. The effects of ICSs are evident in reducing inflammation and exacerbations but whether this alters the natural history of asthma is very contentious. Intervention with ICSs in several infant or paediatric populations did not appear to alter lung function, nor did it lower the incidence of asthma diagnosed temporally.[40,66]

In support of an effect of exacerbations upon disease progression, a posthoc analysis of the START study demonstrated that accelerated lung function decline was more marked in those who experienced severe exacerbations; ICSs conferred a protective effect by attenuating this rate of decline in adults and children.[41] The posthoc analysis of the study[41] showed the potential effects of ICSs in preventing lung function decline by reducing exacerbation frequency. Patients on placebo who exacerbated had upto a 4.5% FEV1 decline compared to the arm who were on treatment with ICSs and had no exacerbation – this group had only a 1.6% decline. Patients on both treatment and placebo arms who did not experience any exacerbations had no significant differences in their lung function or the rate of decline. Therefore, the impact of ICSs upon disease progression in asthma warrants further study.

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