Thirteen-year follow-up of early intervention with an inhaled corticosteroid in patients with asthma

Background

In a 3-year study, adult patients who recently developed asthma (symptoms for less than 1 year) were treated for 2 years with the inhaled corticosteroid (ICS) budesonide (early therapy) or terbutaline. During the third year of the study, terbutaline-treated patients received budesonide (delayed therapy). Differences in lung function and bronchial responsiveness to histamine were observed between the 2 groups.

Objective

We compared the effects of early versus delayed budesonide therapy after a 10-year follow-up period (13 years after the study began) and current real-life data.

Methods

Of the original 103 patients, 90 were re-examined 13 years after study initiation. After the third year of the study, all patients had their medications, including the dose of ICS, individually adjusted.

Results

After the follow-up period, lung function was within the normal range for the entire group (all patients); bronchial responsiveness significantly improved compared with baseline data. No statistically significant differences in clinical or functional variables were found between patients given early or delayed budesonide therapy. However, the delayed therapy group had a higher neutrophil count and higher concentrations of eosinophilic cationic protein and myeloperoxidase in induced sputum. This group had also used more asthma medication and hospital days.

Conclusions

Patients with relatively mild asthma who received ICS within 12 months of their first asthma symptoms or after a 2-year delay achieved equally good functional control of asthma after 10 years of individualized therapy. However, the delayed therapy group exhibited slightly less optimal disease control and more signs of airway inflammation.

Key words: Asthma, asthma control, budesonide, early intervention, inhaled corticosteroids, prebronchodilator FEV1, terbutaline

Abbreviations used: ECP, Eosinophilic cationic protein, FENO, Fractionated exhaled nitric oxide, FVC, Forced vital capacity, ICS, Inhaled corticosteroid, PC15, Provocative concentration of histamine diphosphate causing a decrease in FEV1 of 15%, PEF, Peak expiratory flow, START, Inhaled Steroid Treatment as Regular Therapy in Early Asthma