Time-dependent effects of inhaled corticosteroids on lung function, bronchial hyperresponsiveness, and airway inflammation in asthma

Vinay Mehta, Jeffrey R. Stokes, Abdo Berro, Francisco A. Romero, Thomas B. Casale

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background: Exhaled nitric oxide (FENO) and exhaled breath condensate (EBC) are noninvasive markers that directly measure airway inflammation and may potentially be useful in assessing asthma control and response to therapy. Objective: To examine the time-dependent effects of inhaled corticosteroids on FENO and EBC markers concomitantly with lung function and bronchial hyperresponsiveness. Methods: Eleven steroid-naive adults with mild-to-moderate persistent asthma were treated with mometasone furoate dry powder inhaler, 400 μg/d, for 8 weeks, followed by a 4-week washout. Forced expiratory volume in 1 second (FEV1), the concentration of methacholine calculated to cause a 20% decline in FEV1 (PC 20), FENO, EBC pH, and EBC nitrite measurements before, during, and after treatment were analyzed and compared. Results: The mean (SEM) FEV1 increased from 3.01 (0.13) L (82% predicted) to 3.24 (0.18) L (87% predicted) by week 8 (P < .05). The PC20 level increased from 1.28 (0.31) mg/mL to 2.99 (0.51) mg/mL by treatment week 8 (P < .05) and remained relatively stable through washout week 4 (P < .05). The F ENO level decreased from 31.1 (4.1) ppb to 20.6 (4.5) ppb by treatment week 1 (P < .01), remained low through treatment week 8 (P < .01), then trended back to the baseline level by washout week 1 (P < .01). The median EBC pH increased from 7.81 (interquartile range, 7.49-8.09) to 8.02 (interquartile range, 7.87-8.12) by treatment week 4, but did not achieve statistical significance. The EBC nitrite level decreased from 17.6 (1.6) μM to 9.3 (0.9) μM by treatment week 8 (P < .01), and remained low throughout washout week 4 (P < .05). There was a negative correlation between F ENO and PC20 (Spearman rank correlation coefficient =-0.50, P < .001). Conclusion: The FENO level responded the earliest to treatment and withdrawal of inhaled corticosteroids, whereas changes in EBC markers were delayed but more sustained.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalAnnals of Allergy, Asthma and Immunology
Volume103
Issue number1
DOIs
StatePublished - Jul 2009
Externally publishedYes

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