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. 2003 Dec;58(12):1042–1047. doi: 10.1136/thorax.58.12.1042

Perception of airway narrowing during reduction of inhaled corticosteroids and asthma exacerbation

C Salome 1, J Leuppi 1, R Freed 1, G Marks 1
PMCID: PMC1746534  PMID: 14645970

Abstract

Background: The perception of airway narrowing is reduced in subjects with severe asthma and may be related to the severity of airway inflammation. A study was undertaken to determine if the perception of airway narrowing changes during the reduction of inhaled corticosteroid (ICS) dose or during an asthma exacerbation.

Methods: Forty two asthmatic subjects with well controlled asthma had their daily ICS dose halved every 2 months until they were weaned off ICS or they developed an exacerbation. Perception was measured at baseline and at monthly intervals during bronchial challenge with mannitol as the slope and intercept of the regression of the Borg score and percentage fall in forced expiratory volume in 1 second (FEV1), and as the Borg score at 20% fall in FEV1 (PS20FEV1). Sputum was collected for measurement of inflammatory cell numbers.

Results: In 33 subjects who successfully halved their ICS dose without exacerbation there were significant reductions in slope (p = 0.01), intercept (p = 0.01), and PS20FEV1 (p = 0.003). Sputum eosinophils and airway hyperresponsiveness increased significantly but, in 14 subjects from whom sputum was obtained, changes in eosinophils were not correlated with changes in perception. Change in airway hyperresponsiveness correlated with change in PS20FEV1 (r = –0.40, p = 0.025). In 27 subjects who developed an exacerbation, slope decreased (p = 0.02) and intercept increased (p = 0.01) compared with the visit before the exacerbation. Changes in intercept correlated with changes in resting FEV1 (r = –0.57, p = 0.002).

Conclusions: Perception of airway narrowing decreases during ICS dose reduction and decreases further during a mild asthma exacerbation. These changes are related to concurrent changes in airway hyperresponsiveness and resting lung function. The effect of changes in airway inflammation on perception is unclear.

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Selected References

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  1. Anderson S. D., Brannan J., Spring J., Spalding N., Rodwell L. T., Chan K., Gonda I., Walsh A., Clark A. R. A new method for bronchial-provocation testing in asthmatic subjects using a dry powder of mannitol. Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):758–765. doi: 10.1164/ajrccm.156.3.9701113. [DOI] [PubMed] [Google Scholar]
  2. Bijl-Hofland I. D., Cloosterman S. G., Folgering H. T., Akkermans R. P., van Schayck C. P. Relation of the perception of airway obstruction to the severity of asthma. Thorax. 1999 Jan;54(1):15–19. doi: 10.1136/thx.54.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bijl-Hofland I. D., Cloosterman S. G., Folgering H. T., Akkermans R. P., van den Hoogen H., van Schayck C. P. Measuring breathlessness during histamine challenge: a simple standardized procedure in asthmatic patients. Eur Respir J. 1999 May;13(5):955–960. doi: 10.1034/j.1399-3003.1999.13e05.x. [DOI] [PubMed] [Google Scholar]
  4. Bijl-Hofland I. D., Cloosterman S. G., Folgering H. T., van den Elshout F. J., van Weel C., van Schayck C. P. Inhaled corticosteroids, combined with long-acting beta(2)-agonists, improve the perception of bronchoconstriction in asthma. Am J Respir Crit Care Med. 2001 Sep 1;164(5):764–769. doi: 10.1164/ajrccm.164.5.9910103. [DOI] [PubMed] [Google Scholar]
  5. Bijl-Hofland I. D., Folgering H. T., van den Hoogen H., Cloosterman S. G., Van Weel C., Donkers J. M., van Schayck C. P. Perception of bronchoconstriction in asthma patients measured during histamine challenge test. Eur Respir J. 1999 Nov;14(5):1049–1054. doi: 10.1183/09031936.99.14510499. [DOI] [PubMed] [Google Scholar]
  6. Boulet L. P., Leblanc P., Turcotte H. Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest. 1994 May;105(5):1430–1433. doi: 10.1378/chest.105.5.1430. [DOI] [PubMed] [Google Scholar]
  7. Burdon J. G., Juniper E. F., Killian K. J., Hargreave F. E., Campbell E. J. The perception of breathlessness in asthma. Am Rev Respir Dis. 1982 Nov;126(5):825–828. doi: 10.1164/arrd.1982.126.5.825. [DOI] [PubMed] [Google Scholar]
  8. Chetta A., Gerra G., Foresi A., Zaimovic A., Del Donno M., Chittolini B., Malorgio R., Castagnaro A., Olivieri D. Personality profiles and breathlessness perception in outpatients with different gradings of asthma. Am J Respir Crit Care Med. 1998 Jan;157(1):116–122. doi: 10.1164/ajrccm.157.1.9702093. [DOI] [PubMed] [Google Scholar]
  9. Gibson P. G., Wlodarczyk J., Hensley M. J., Murree-Allen K., Olson L. G., Saltos N. Using quality-control analysis of peak expiratory flow recordings to guide therapy for asthma. Ann Intern Med. 1995 Oct 1;123(7):488–492. doi: 10.7326/0003-4819-123-7-199510010-00002. [DOI] [PubMed] [Google Scholar]
  10. Gibson P. G., Wong B. J., Hepperle M. J., Kline P. A., Girgis-Gabardo A., Guyatt G., Dolovich J., Denburg J. A., Ramsdale E. H., Hargreave F. E. A research method to induce and examine a mild exacerbation of asthma by withdrawal of inhaled corticosteroid. Clin Exp Allergy. 1992 May;22(5):525–532. doi: 10.1111/j.1365-2222.1992.tb00161.x. [DOI] [PubMed] [Google Scholar]
  11. James A. L., Carroll N., De Klerk N., Elliott J., Musk A. W., Ryan G. Increased perception of airway narrowing in patients with mild asthma. Respirology. 1998 Dec;3(4):241–245. doi: 10.1111/j.1440-1843.1998.tb00129.x. [DOI] [PubMed] [Google Scholar]
  12. Knudson R. J., Lebowitz M. D., Holberg C. J., Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983 Jun;127(6):725–734. doi: 10.1164/arrd.1983.127.6.725. [DOI] [PubMed] [Google Scholar]
  13. Leuppi J. D., Salome C. M., Jenkins C. R., Anderson S. D., Xuan W., Marks G. B., Koskela H., Brannan J. D., Freed R., Andersson M. Predictive markers of asthma exacerbation during stepwise dose reduction of inhaled corticosteroids. Am J Respir Crit Care Med. 2001 Feb;163(2):406–412. doi: 10.1164/ajrccm.163.2.9912091. [DOI] [PubMed] [Google Scholar]
  14. Marks G. B., Yates D. H., Sist M., Ceyhan B., De Campos M., Scott D. M., Barnes P. J. Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate. Thorax. 1996 Aug;51(8):793–798. doi: 10.1136/thx.51.8.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Massaro A. F., Gaston B., Kita D., Fanta C., Stamler J. S., Drazen J. M. Expired nitric oxide levels during treatment of acute asthma. Am J Respir Crit Care Med. 1995 Aug;152(2):800–803. doi: 10.1164/ajrccm.152.2.7633745. [DOI] [PubMed] [Google Scholar]
  16. Pizzichini E., Pizzichini M. M., Efthimiadis A., Evans S., Morris M. M., Squillace D., Gleich G. J., Dolovich J., Hargreave F. E. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):308–317. doi: 10.1164/ajrccm.154.2.8756799. [DOI] [PubMed] [Google Scholar]
  17. Reddel H. K., Jenkins C. R., Marks G. B., Ware S. I., Xuan W., Salome C. M., Badcock C. A., Woolcock A. J. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J. 2000 Aug;16(2):226–235. doi: 10.1034/j.1399-3003.2000.16b08.x. [DOI] [PubMed] [Google Scholar]
  18. Roisman G. L., Peiffer C., Lacronique J. G., Le Cae A., Dusser D. J. Perception of bronchial obstruction in asthmatic patients. Relationship with bronchial eosinophilic inflammation and epithelial damage and effect of corticosteroid treatment. J Clin Invest. 1995 Jul;96(1):12–21. doi: 10.1172/JCI118011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Salome C. M., Roberts A. M., Brown N. J., Dermand J., Marks G. B., Woolcock A. J. Exhaled nitric oxide measurements in a population sample of young adults. Am J Respir Crit Care Med. 1999 Mar;159(3):911–916. doi: 10.1164/ajrccm.159.3.9802108. [DOI] [PubMed] [Google Scholar]
  20. Salome Cheryl M., Reddel Helen K., Ware Sandra I., Roberts Alyson M., Jenkins Christine R., Marks Guy B., Woolcock Ann J. Effect of budesonide on the perception of induced airway narrowing in subjects with asthma. Am J Respir Crit Care Med. 2002 Jan 1;165(1):15–21. doi: 10.1164/ajrccm.165.1.2106130. [DOI] [PubMed] [Google Scholar]
  21. Simon P. M., Schwartzstein R. M., Weiss J. W., Fencl V., Teghtsoonian M., Weinberger S. E. Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis. 1990 Nov;142(5):1009–1014. doi: 10.1164/ajrccm/142.5.1009. [DOI] [PubMed] [Google Scholar]
  22. Turcotte H., Boulet L. P. Perception of breathlessness during early and late asthmatic responses. Am Rev Respir Dis. 1993 Aug;148(2):514–518. doi: 10.1164/ajrccm/148.2.514. [DOI] [PubMed] [Google Scholar]
  23. Veen J. C., Smits H. H., Ravensberg A. J., Hiemstra P. S., Sterk P. J., Bel E. H. Impaired perception of dyspnea in patients with severe asthma. Relation to sputum eosinophils. Am J Respir Crit Care Med. 1998 Oct;158(4):1134–1141. doi: 10.1164/ajrccm.158.4.9710087. [DOI] [PubMed] [Google Scholar]
  24. Wilson R. C., Jones P. W. Influence of prior ventilatory experience on the estimation of breathlessness during exercise. Clin Sci (Lond) 1990 Feb;78(2):149–153. doi: 10.1042/cs0780149. [DOI] [PubMed] [Google Scholar]
  25. Wilson R. C., Oldfield W. L., Jones P. W. Effect of residence at altitude on the perception of breathlessness on return to sea level in normal subjects. Clin Sci (Lond) 1993 Feb;84(2):159–167. doi: 10.1042/cs0840159. [DOI] [PubMed] [Google Scholar]

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