Severe Exacerbations and Decline in Lung Function in Asthma
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- 1 January 2009
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 179 (1), 19-24
- https://doi.org/10.1164/rccm.200807-1126oc
Abstract
To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma. To determine whether severe asthma exacerbations are associated with a persistent decline in lung function. The START (inhaled steroid treatment as regular therapy in early asthma) study was a 3-year, randomized, double-blind study of 7,165 patients (5-66 yr) with persistent asthma for less than 2 years, to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function. There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable, 190 in the placebo group and 115 in the budesonide group. In the placebo group, the change in post-bronchodilator FEV(1) % predicted from baseline to the end of the study, in patients who did or did not experience a severe exacerbation was -6.44% and -2.43%, respectively (P < 0.001). A significant difference was seen in both children and in adults, but not in adolescents. In the budesonide group, the change in the post-bronchodilator FEV(1) % predicted in patients who did or did not experience a severe exacerbation was -2.48% and -1.72%, respectively (P = 0.57). The difference in magnitude of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not, was statistically significant (P = 0.042). Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses of inhaled corticosteroid is associated with an attenuation of the decline.Keywords
This publication has 21 references indexed in Scilit:
- Global strategy for asthma management and prevention: GINA executive summaryEuropean Respiratory Journal, 2008
- Risk Factors Associated With Persistent Airflow Limitation in Severe or Difficult-to-Treat AsthmaChest, 2007
- Severe exacerbations predict excess lung function decline in asthmaEuropean Respiratory Journal, 2007
- Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for AsthmaNew England Journal of Medicine, 2006
- Progression of Asthma Measured by Lung Function in the Childhood Asthma Management ProgramAmerican Journal of Respiratory and Critical Care Medicine, 2004
- A Longitudinal, Population-Based, Cohort Study of Childhood Asthma Followed to AdulthoodNew England Journal of Medicine, 2003
- Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary diseaseThorax, 2002
- A 15-Year Follow-up Study of Ventilatory Function in Adults with AsthmaNew England Journal of Medicine, 1998
- Effects of Reducing or Discontinuing Inhaled Budesonide in Patients with Mild AsthmaNew England Journal of Medicine, 1994
- Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic childrenRespiratory Medicine, 1994