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Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system.

ABSTRACT: BACKGROUND:Cough variant asthma (CVA) is one of the most common causes of chronic persistent cough, and early treatment with inhaled corticosteroids (ICSs) is recommended to attenuate the inflammation and remodeling. The impulse oscillometry system (IOS) is a novel device for respiratory functional assessment that has not yet been assessed in terms of CVA. Therefore, we investigated the relationship between CVA and IOS, and the difference in therapeutic effects of ICSs among the subtype classifications by IOS. METHODS:The following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). Treatment effects were assessed by the Leicester cough questionnaire (LCQ) and were compared among three separated subtypes based on IOS measurements: central, peripheral, and resistless. RESULTS:Regarding LCQ scores, in the central type, the LCQ of the MF group was significantly lower than FP and BUD. In the peripheral type, the LCQ of the FP group was significantly lower than MF and BUD. In the resistless type, the LCQ of the MF group was significantly lower than BUD. Also, IOS factors were improved by 4 weeks of therapy with ICS. Thus, there was strong relationship between subtypes and particle size in terms of effectiveness. CONCLUSIONS:There is a strong relationship between IOS subtype classification and ICS particle size in terms of therapeutic efficiency in CVA. It appears important to determine the ICS particle size, based on the IOS subtype classification, before treatment.

SUBMITTER: Sugawara H

PROVIDER: S-EPMC6390374 | biostudies-other | 2019 Feb

REPOSITORIES: biostudies-other

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Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system.

Sugawara Hiroyuki H Saito Atsushi A Yokoyama Saori S Tsunematsu Kazunori K Takahashi Hiroki H

Respiratory research 20190226 1

<h4>Background</h4>Cough variant asthma (CVA) is one of the most common causes of chronic persistent cough, and early treatment with inhaled corticosteroids (ICSs) is recommended to attenuate the inflammation and remodeling. The impulse oscillometry system (IOS) is a novel device for respiratory functional assessment that has not yet been assessed in terms of CVA. Therefore, we investigated the relationship between CVA and IOS, and the difference in therapeutic effects of ICSs among the subtype ...[more]

PMID: 30808365

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Project description:BackgroundFor children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking.MethodsWe randomly assigned 182 children (6 to 17 years of age), who had uncontrolled asthma while receiving 100 microg of fluticasone twice daily, to receive each of three blinded step-up therapies in random order for 16 weeks: 250 microg of fluticasone twice daily (ICS step-up), 100 microg of fluticasone plus 50 microg of a long-acting beta-agonist twice daily (LABA step-up), or 100 microg of fluticasone twice daily plus 5 or 10 mg of a leukotriene-receptor antagonist daily (LTRA step-up). We used a triple-crossover design and a composite of three outcomes (exacerbations, asthma-control days, and the forced expiratory volume in 1 second) to determine whether the frequency of a differential response to the step-up regimens was more than 25%.ResultsA differential response occurred in 161 of 165 patients who were evaluated (P<0.001). The response to LABA step-up therapy was most likely to be the best response, as compared with responses to LTRA step-up (relative probability, 1.6; 95% confidence interval [CI], 1.1 to 2.3; P=0.004) and ICS step-up (relative probability, 1.7; 95% CI, 1.2 to 2.4; P=0.002). Higher scores on the Asthma Control Test before randomization (indicating better control at baseline) predicted a better response to LABA step-up (P=0.009). White race predicted a better response to LABA step-up, whereas black patients were least likely to have a best response to LTRA step-up (P=0.005).ConclusionsNearly all the children had a differential response to each step-up therapy. LABA step-up was significantly more likely to provide the best response than either ICS or LTRA step-up. However, many children had a best response to ICS or LTRA step-up therapy, highlighting the need to regularly monitor and appropriately adjust each child's asthma therapy. (ClinicalTrials.gov number, NCT00395304.)

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Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system.

Publications

Comparison of therapeutic effects of inhaled corticosteroids on three subtypes of cough variant asthma as classified by the impulse oscillometry system.

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