Berita Kesehatan
Asthma progression and mortality: The role of inhaled corticosteroid
Sabtu, 04 Mei 2019 15:36:55

Paul O'ByrneLeonardo M. FabbriIan D. PavordAlberto PapiStefano PetruzzelliPeter Lange

European Respiratory Journal 2019; DOI: 10.1183/13993003.00491-2019

Abstract

Overall, asthma mortality rates have declined dramatically in the last 30 years, due to improved diagnosis and to better treatment, particularly in the 1990s following the more widespread use of inhaled corticosteroids (ICS). The impact of ICS on other long-term outcomes, such as lung function decline, is less certain, in part because the factors associated with these outcomes are incompletely understood. The purpose of this review is to evaluate the effect of pharmacological interventions, particularly ICS, on asthma progression and mortality. Furthermore, the potential mechanisms of action of pharmacotherapy on asthma progression and mortality, the effects of ICS on long-term changes in lung function, and the role of ICS in various asthma phenotypes is reviewed.

Overall, there is compelling evidence of the value of ICS in improving asthma control, as measured by improved symptoms, pulmonary function and reduced exacerbations. There is, however, less convincing evidence that ICS prevent the decline in pulmonary function that occurs in some, although not all, patients with asthma. Severe exacerbations are associated with a more rapid decline in pulmonary function, and by reducing the risk of severe exacerbations, it is likely that ICS will, at least partially, prevent this decline. Studies using administrative databases also support an important role for ICS in reducing asthma mortality, but the fact that asthma mortality is, fortunately, an uncommon event, make it highly improbable that this will be demonstrated in prospective trials.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Paul O'Byrne

Conflict of interest: Dr. Fabbri reports personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Chiesi, personal fees and non-financial support from GSK, personal fees and non-financial support from Novartis, personal fees and non-financial support from Menarini, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Zambon, personal fees and non-financial support from Pearl Therapeutics, non-financial support from Dompe, outside the submitted work.

Conflict of interest: Dr. Pavord reports personal fees from AstraZeneca, personal fees from GSK, personal fees from Boehringer Ingelheim, grants and personal fees from Chiesi, personal fees from Sanofi/Regeneron, personal fees from Circassia, personal fees from Merck, personal fees from Novartis, personal fees from Mundipharma, personal fees from Teva, personal fees from Knopp, grants and personal fees from Afferent, personal fees from Roche/Genentech, outside the submitted work.

Conflict of interest: Dr. Papi reports grants, personal fees, non-financial support and other from Chiesi, grants, personal fees, non-financial support and other from AstraZeneca, grants, personal fees, non-financial support and other from GlaxoSmithKline, grants, personal fees, non-financial support and other from Boehringer Ingelheim, personal fees and non-financial support from Menarini, personal fees and non-financial support from Novartis, personal fees and non-financial support from Zambon, grants, personal fees, non-financial support and other from Mundipharma, grants, personal fees, non-financial support and other from TEVA, grants from Sanofi, outside the submitted work.

Conflict of interest: Dr. Petruzzelli reports and Employed by Chiesi Farmaceutici SpA, the sponsor of the studies.

Conflict of interest: Dr. Lange reports grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Chiesi, grants and personal fees from GSK, outside the submitted work.

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