Abstract
BACKGROUND: Asthma treatment guidelines are mainly based on symptoms & spirometry. There is concern regarding persistent underlying small airways disease in asthmatics despite standard care. Impulse oscillometry (IOS) measures small airway function.
METHODS: We analysed community referral data from asthmatics (n=378) on standard community stepwise therapy, who had spirometry, IOS & exhaled nitric oxide (FeNO) performed.
RESULTS: Patients receiving extra-fine (EF) particle inhaled corticosteroids (ICS) at Step 2 demonstrated improved resistance at 5Hz (R5%) by 14.2% but no difference in spirometry.
For Step 3&4 patients, R5% remained elevated (137%) despite the use of long acting beta agonists (LABA) with no difference without LABA: <5% of step 3/4 patients were using EF ICS with no EF ICS/LABA use.
CONCLUSION: There is an unmet need in terms of treating small airways disease in asthma. EF ICS showed improved R5% (step 2). Studies with EF ICS +/-LABA at step 3/4 are required to discern any change in small airways function through greater peripheral deposition.
- © 2012 ERS