Am. J. Respir. Crit. Care Med., Vol 151, No. 2, Feb 1995, 360-368.
Importance of total serum IgE for improvement in airways hyperresponsiveness with inhaled corticosteroids in asthma and chronic obstructive pulmonary disease. The Dutch CNSLD Study Group
HA Kerstjens, JP Schouten, PL Brand, DF Schoonbrood, PJ Sterk and DS Postma
Department of Pulmonary Medicine, University Hospital Groningen, The Netherlands.
Airways hyperresponsiveness is a hallmark of asthma, and many patients with
COPD also demonstrate hyperresponsiveness. Inhaled corticosteroids improve
hyperresponsiveness, but the extent of improvement may vary considerably
between patients. This study was designed to determine which patient
characteristics predict these differences in response. Patients with mild
to moderately severe obstructive airways disease (asthma and COPD) were
selected if PC20 < or = 8 mg/ml and FEV1 < 95% confidence interval of
predicted normal. They were followed for 2.5 yr, during which one-third
received inhaled corticosteroids. The independent influences of baseline
FEV1/IVC, bronchodilator response, PC20, smoking habits, allergy, age, and
sex on the improvement in airways hyperresponsiveness with inhaled
corticosteroids were analyzed. Total serum IgE was taken as a parameter of
allergy, next to specific IgE for house dust mite, skin tests, and blood
eosinophils. Total serum IgE was found to be the most important and single
independent predictor of change in PC20 with inhaled corticosteroids:
patients with a higher IgE had a greater increase in PC20 when administered
inhaled corticosteroids than those with lower IgE levels. Alternatively,
patients with a higher IgE who did not receive corticosteroids had a
decrease in PC20 compared with patients with a lower IgE. This effect was
most prominent in asthma but was inconsistent in asthmatic bronchitis and
COPD. The level of IgE cannot be used to predict the response to inhaled
corticosteroids in individuals accurately. Total serum IgE is the single
most important predictor of change in PC20 with and without inhaled
corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)
