Chest
Volume 108, Issue 5, November 1995, Pages 1228-1234
Journal home page for Chest

Clinical Investigations: Airways Obstruction
Effect of Early vs Late Intervention With Inhaled Corticosteroids in Asthma

https://doi.org/10.1378/chest.108.5.1228Get rights and content

One hundred five consecutive patients with mild or moderate asthma not earlier treated with inhaled corticosteroids and with a need of an inhaled bronchodilator of three or more doses a week, and/or asthma symptoms during day or night, and/or peak expiratory flow (PEF) or FEV1 less than 75% of predicted normal values were given an inhaled corticosteroid for 2 years (budesonide delivered via an inspiratory flow-driven multidose dry powder inhaler [Turbuhaler]). According to duration of symptoms, they were divided into six groups; from a duration less than 6 months up to a duration more than 10 years. PEF and FEV1 were measured before and after treatment for 3 months, 1 year, and 2 years. In the groups of patients with a duration of symptoms less than 2 years, mean FEV1 and PEF were significantly higher at all time points as compared with the baseline and as compared with the groups of patients with a longer duration of asthma symptoms. The maximum effects were usually seen after 1 year's treatment with maintained control during the second year. A significant negative correlation was found between duration of symptoms and maximum increases in PEF (r=-0.34;p=0.0006) and FEV1 (r=-0.32;p=0.0012), a correlation remaining also after correcting for baseline airway function. No correlation was found between the age of the patients or earlier regular use of ß2-agonists and improvements in airway function. The results give some evidence that early treatment of asthma with an inhaled steroid may prevent patients from developing chronic airway obstruction. They also support current asthma treatment guidelines advocating early introduction of inhaled anti-inflammatory drugs.

Section snippets

Aim of the Study

The aim of the study was to evaluate the possible correlation between response to treatment and the duration of subjective asthma symptoms in a group of patients treated for the first time with an inhaled corticosteroid and followed up for 2 years.

Patients

During the period from February 1, 1990, to June 30, 1991, we decided to start treatment with inhaled corticosteroids in all patients with asthma with use of inhaled bronchodilators of more than three doses a week, and/or regular asthma symptoms

Results

There were more female than male patients in five of the six groups. Their mean age increased with an increasing duration of symptoms. The distribution of atopy was equal in all groups of patients.

The results of lung function measurements are shown in Figures 1 through 6.

Discussion

Several national asthma management and treatment guidelines have been issued2, 3, 4 and an international consensus report written.5 They all underline the importance of anti-inflammatory treatment of asthma. They also state that anti-inflammatory treatment should be started early, but without defining “early” in terms of months or years after diagnosis within which treatment should be started.

The information about the inflammatory nature of asthma prompted us to change our treatment strategy in

Acknowledgment

The authors would like to thank Auli Lindholm, RN, for technical assistance, and Tore Persson, PhD, for the statistical analyses and advice.

References (16)

There are more references available in the full text version of this article.

Cited by (350)

  • Asthma and Allergy

    2022, Clinical Immunology
View all citing articles on Scopus
View full text