Abstract
Background: Inhaled corticosteroids (ICS) are the basic treatment in patients with asthma. The aim of the study was to find predictors which detect subjects who clinically benefit from ICS using a combined endpoint (improvement in either FEV1 [>12% and >200ml], Juniper asthma control questionnaire [ACQ] >0.5 or asthma quality of life questionnaire [AQLQ] >0.5).
Methods: 70 treatment-naïve subjects (mean age 40.3 years (range 18-70); 21 male) with suspected asthma were randomised to inhale ciclesonide (320mcg/day, n= 34) or placebo (n= 36) in a double-blind manner for 1 month. Spirometry, airway hyperresponsiveness (AHR) to mannitol and to methacholine, exhaled nitric oxide, ACQ and AQLQ were assessed before and after treatment.
Results: An improvement in the combined endpoint was seen in 16 subjects (47%) in the ciclesonide group (1 FEV1, 9 ACQ, 14 AQLQ) and in 15 subjects (42%) in the placebo group (2 FEV1, 5 ACQ, 13 AQLQ). AHR to mannitol was found in 8/16 responders and only 3/18 non-responders in the ciclesonide group (sensitivity 50%, specificity 83%, PPV 72%, NPV 65%, p=0.038). Using a logistic regression analysis, AHR to mannitol was the only significant predictor of a response to ciclesonide with an odds ratio of 5.0 (95%CI 1.03-24.28, p=0.046).
Conclusions: In subjects with suspected asthma, AHR to mannitol is a predictor of subsequent response to ICS treatment.
- © 2012 ERS