SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
9/6/05
Asthma treatment prevents remodeling
Summary
Background - Most asthma treatment guidelines stress reduction of symptoms, improved quality of life and of pulmonary function. However, it is now recognized that prevention of airway remodeling (ARem) in asthma may be important in preventing irreversible airway obstruction. Does current asthma treatment prevent ARem?
Findings - Bibi et al of Ben Gurion University in Israel compared the post-bronchodilator FEV-1/FVC ratios sequentially over 5 years in 2 groups of asthmatic children: Group I (n=148) treated daily with inhaled corticosteroids (ICS) vs Group II - those with mild, intermittent asthma not treated with ICS but only with pre inhaled beta agonists.
They found that after 5 years the frequency of low post-bronchodilator FEV-1/FVC ratios decreased from 35% to 21% in Group I patients while the frequency of low post-bronchodilator FEV-1/FVC ratios increased from 10% to 28% in Group II children. The authors concluded that even children with mild, intermittent asthma are at risk for ARem (as indicated by more frequent low post-bronchodilator FEV-1/FVC ratios); such changes can be prevented by daily ICS treatment.
Reference
Resp Med 2005; July 23, E pub.
Editor's Comments
These findings appear to support the concept of using daily ICS treatment even in mild persistent asthma to prevent ARem. However, in at least 2 large studies reported in the New Eng J Med (CAMP study; Boushey et al), there was no significant difference in the post-bronchodilator FVC in childhood persistent asthmatics who did/did not receive daily ICS therapy. Perhaps the difference in post bronchodilator outcome measurements (FVC vs FEV-1/FVC ratios) used may explain the differing conclusions about the value of daily ICS therapy in such situations.
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