Chest
Volume 130, Issue 1, July 2006, Pages 58-65
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Original Research
Improvement in Bronchodilation Following Deep Inspiration After a Course of High-Dose Oral Prednisone in Asthma

https://doi.org/10.1378/chest.130.1.58Get rights and content

Background

Bronchodilation following deep inspiration is usually impaired in patients with asthma. This might be due to changes in airway mechanics in the presence of inflammation or structural changes within the airways. Although inhaled corticosteroid treatment has been shown to improve airway responses to deep inspiration in patients with asthma, airway inflammation can persist despite inhaled corticosteroid treatment, and thus could still influence the airway mechanics during deep breaths. We hypothesized that oral steroid treatment further optimizes deep inspiration-induced bronchodilation in clinically stable asthmatic patients who are receiving therapy with inhaled corticosteroids.

Methods

Twenty-four atopic patients with mild-to-moderate persistent asthma (FEV1, > 70% predicted; provocative concentration of methacholine causing a 20% fall in FEV1 [PC20], < 8 mg/mL), who were treated with 250 to 2,000 μg of beclomethasone-dipropionate or equivalent, participated in a parallel-design, double-blind study. Before and after treatment with 0.5 mg/kg/d prednisone or placebo for 14 days, a methacholine challenge was performed. Deep inspiration-induced bronchodilation was measured by the ratio of flow at 40% of FVC on the flow-volume curve after maximal inspiration/flow at 40% of FVC on the flow-volume curve after partial (60% of FVC) inspiration (M/P ratio).

Results

The M/P ratio significantly increased from a mean of 1.31 (range, 1.0 to 1.7) to 1.49 (range, 1.1 to 2.3) in the prednisone group. Interestingly, the improvement in the M/P ratio did not correlate with an accompanying significant increase in PC20 for methacholine (mean change, 1.02; SD doubling dose, 0.97) and a decrease in exhaled nitric oxide (mean change, 14 parts per billion [ppb]; SD, 33.4 ppb).

Conclusions

Systemic antiinflammatory treatment in addition to maintenance therapy with inhaled corticosteroids increases bronchodilation by deep inspiration in patients with mild-to-moderate persistent asthma. This suggests that residual inflammation impairs airway mechanics in asthma patients.

Section snippets

Subjects

Twenty-four nonsmoking, atopic subjects with mild-to-moderate persistent asthma, according to Global Initiative for Asthma guidelines,18 participated in this study. All subjects had experienced symptoms of episodic chest tightness or wheezing within the previous 12 months, had a baseline FEV1 of > 70% of predicted,19 and had a provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) of < 8 mg/mL.20 All patients were atopic, which was determined by a positive skin-prick test

Results

All patients completed the study. There were no baseline differences between the two treatment groups with respect to age, sex, medication use, FEV1, exhaled NO levels, and M/P ratio (Table 1). However, there was a significant difference in the PC40V′40P for methacholine at baseline between the two groups (p = 0.016), and a trend toward a difference in the PC20 for methacholine (p = 0.057). Furthermore, there was no significant difference in the Asthma Control Questionnaire score between the

Discussion

The results of this study demonstrate that a course of high-dose oral prednisone therapy improves the degree of deep inspiration-induced bronchodilation at a given level of airways obstruction in stable patients with asthma who are receiving regular treatment with inhaled corticosteroids. It appears that this improvement is not related to concurrent reductions in airway hyperresponsiveness or to changes in the level of exhaled NO. These findings indicate that the degree of bronchodilation

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    This study was supported by the Netherlands Asthma Foundation (grant 3.2.02.34).

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