Bronchial Hyperresponsiveness in the Assessment of Asthma Control

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Bronchial Hyperresponsiveness in the Assessment of Asthma Control John D. Brannan, PhD CHEST Volume 138, Issue 2, Pages 11S-17S (August 2010) DOI: 10.1378/chest.10-0231 Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 1 A summary of the improvement in bronchial hyperresponsiveness (BHR) following treatment with inhaled corticosteroids (ICS) (□: fluticasone; ▪: budesonide or beclomethasone; expressed as PD20 or PC20) from six studies using either histamine21 or methacholine.10,22–25 BHR to direct stimuli remains in the presence of high doses of ICS over short- and long-term treatment periods. PC20 = provoking concentration causing a 20% fall in FEV1; PD20 = provoking dose causing a 20% fall in FEV1. CHEST 2010 138, 11S-17SDOI: (10.1378/chest.10-0231) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 2 (A) Mean values for the fall in FEV1 expressed as a percentage of the baseline value for FEV1 after exercise in 19 children with asthma who received different doses of budesonide in random order for 4 weeks. The data demonstrate a dose-response relationship between severity of exercise-induced asthma and the dose of inhaled steroid; 100 μg was more effective than placebo (***P < .0001), 200 μg was more effective than 100 μg (*P < .01), and 400 μg was more effective than 200 μg (***P < .0001). (B) The change in symptoms and PEFR in relation to dose of inhaled budesonide in children with asthma who performed the exercise challenge as shown in A. The data illustrate that symptoms and PEFR resolved at low doses of budesonide, whereas resolution of EIB required higher doses. EIB = exercise-induced bronchoconstriction; PEFR = peak expiratory flow rate. **P < .001 compared with active treatments. (Adapted from data from Pedersen and Hansen.5) CHEST 2010 138, 11S-17SDOI: (10.1378/chest.10-0231) Copyright © 2010 The American College of Chest Physicians Terms and Conditions

Figure 3 Percentage fall in FEV1 after exercise in response to low-dose (40 or 80 μg) and high-dose (160 or 320 μg) ciclesonide according to baseline sputum eosinophil counts. A group with high eosinophils (> 5%, n = 10) (•) demonstrated a significantly greater reduction in EIB from baseline using high-dose ICS compared with a low-dose ICS over 3 weeks. A group with low levels of eosinophils (< 5%, n = 13) (○) showed low- and high-dose ICS has similar benefits on EIB. Changes from baseline were compared within a group (*) and between groups (#) for each dose level at P < .05. Only the sputum eosinophilic group showed a significantly greater change from baseline to high ICS dose compared to low ICS dose (ψ) (P < .05). See Figure 2 for the expansion of the abbreviation. (Reprinted with permission from Duong et al.31) CHEST 2010 138, 11S-17SDOI: (10.1378/chest.10-0231) Copyright © 2010 The American College of Chest Physicians Terms and Conditions