Extract
To the Editor:
Inhaled corticosteroids (ICS) reduce airway inflammation; however, guidelines recommend titrating ICS dose based on symptoms [1], which are not closely associated with airway inflammation [2]. Once symptoms are controlled for ≥3 months, ICS reduction is recommended [3] but step-down is often not implemented. Studies suggest that the majority of patients treated with ICS can have their therapy stepped down, although there is no clear evidence on how best to achieve this [4].
We assessed whether exhaled nitric oxide fraction (FeNO) measurements could predict a loss of symptom control or exacerbation following a reduction in ICS dose in a cohort study of people with well-controlled asthma recruited from primary care.
All participants had a recorded asthma diagnosis, were aged 18–75 years, and had received at least one ICS prescription in the last year. The study was restricted to nonsmokers (<10 pack-years). Poorly compliant participants, and participants with an asthma exacerbation requiring oral steroids in the previous 12 weeks or with a Juniper five-item Asthma Control Questionnaire (ACQ-5)[5] score >1.5 at visit 1 (indicating poor control) were excluded.
Participants were seen at the same time of day on four occasions: days 0, 14, 21 and 110. At each visit, ACQ-5, FeNO (Flex Flow; Aerocrine, Solna, Sweden) and
- Received March 24, 2014.
- Accepted July 24, 2014.
- ©ERS
