Chest
Original ResearchImprovement in Bronchodilation Following Deep Inspiration After a Course of High-Dose Oral Prednisone in Asthma
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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2013, Respiratory Physiology and NeurobiologyCitation Excerpt :Whether this holds true in the presence of severe asthma pathophysiology is unknown. The extent of deep inspiration reversal in asthma is related to inflammation within the airways (Slats et al., 2007) and improves after anti-inflammatory treatment (Lim et al., 1989; Slats et al., 2006), suggesting that more severe airway inflammation is likely to reduce residual dilatation. Since airway inflammation can increase surface tension through its effect on surfactant function (Hohlfeld et al., 2004), an effect of airway inflammation in more severe disease would be consistent with the association between baseline gas trapping and deep inspiration reversal of bronchoconstriction in asthmatic subjects (Pyrgos et al., 2011).
Correlation between airway inflammation and loss of deep-inhalation bronchoprotection in asthma
2008, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Efforts to relate airway hyperresponsiveness and measures of airway inflammation, including sputum and bronchoalveolar lavage eosinophils and fraction of exhaled nitric oxide (FENO), have produced variable results.4-11 Several recent studies have shown that anti-inflammatory therapy can restore both the bronchoprotecting12 and bronchodilating13,14 effects of deep inhalation in patients with mild asthma. In addition, it has been shown that a period of allergen avoidance improved the bronchodilator effects of deep inhalation in patients with asthma.15
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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).