Is Normal Bronchial Responsiveness in Asthmatics a Reliable Index for Withdrawing Inhaled Corticosteroid Treatment?*

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Abstract

Study objective

Inhaled corticosteroid (ICS) treatment is first-line maintenance therapy in bronchial asthma. However, it is not clear whether and when ICS treatment can be withdrawn. The aim of this open study was to assess whether normalization of bronchial responsiveness could be used as a reliable index to assess the opportunity of ICS treatment withdrawal.

Design

Open study at two different points in time.

Setting

Outpatient pulmonary clinic.

Patients

Eighteen asthmatic subjects.

Measurements and results

ICS therapy was withdrawn in subjects treated with beclomethasone dipropionate, at the maintenance dose of 889 +/- 246 [micro sign]g/d for >3 months. Upon recruitment, all subjects were asymptomatic, had FEV1 >70% of predicted value, and were in treatment with beta2-agonists on an as-needed basis. Eight subjects (group 1) had normal bronchial responsiveness (methacholine provocative dose causing a 20% fall in FEV1 [PD20] >2,000 [micro sign]g) and 10 subjects (group 2) had bronchial hyperresponsiveness (BHR) (PD20 Conclusions

Our study shows that the likelihood of asthma exacerbation is not reduced if ICS treatment is withdrawn when the subjects have NBR, but the exacerbation could be delayed. Further studies in larger populations of asthmatics are needed to confirm these findings.

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