Abstract
Objectives: To compare titrating ICS against mannitol airway hyper-responsiveness (AHR) or British Thoracic Society (BTS) outcomes on asthma control over 1 year in the community.
Methods: After an ICS tapering phase, 157 persistent asthmatics were randomised (parallel) and followed for 1 year. Their subsequent ICS dose (as ciclesonide) was titrated against either mannitol PD10 (AHR strategy) or standard BTS outcomes. Study visits were performed in a primary care.
Results: Both groups prior to step down (n=80 AHR, n=77 BTS) were matched by age, sex, FEV1%, mannitol PD10 and pre existing ICS dose. Significantly fewer cumulative episodes of loss of control occurred in the AHR rather than BTS group (84 vs 118, p=0.018), amounting to a 24% lower rate (1.32 v 1.73 episodes of loss of control/patient/year).
Significant improvements were seen in the AHR group for inflammatory markers including mannitol PD10, methacholine PC20, salivary eosinophil cationic protein (ECP), exhaled nitric oxide, symptoms and reliever use. Final mean inhaled Ciclesonide dose was higher (p<0.0001) in AHR group; 514 ug vs 208 ug (BTS), with no significant suppression of overnight urinary cortisol/creatinine.
Conclusions: Managing patients in primary care using mannitol to guide ICS therapy resulted in significant reductions in episodes of loss of control, symptoms and reliever use, along with suppression of inflammatory markers but not adrenal function.
- © 2011 ERS