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Published ahead of print on June 16, 2005, doi:10.1164/rccm.200407-955OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 6, September 2005, 693-699

A more recent version of this article appeared on September 15, 2005
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Submitted on July 22, 2004
Accepted on June 9, 2005

Inhaled Corticosteroids and the Beneficial Effect of Deep Inspiration in Asthma

Nicola Scichilone1, Solbert Permutt2, Vincenzo Bellia3, and Alkis Togias2*

1 Asthma and Allergy Center, Johns Hopkins University, School of Medicine, Baltimore, MD, United States; Istituto di Medicina Generale e Pneumologia, Cattedra di Malattie dell'Apparato Respiratorio, University of Palermo, Palermo, Italy, 2 Asthma and Allergy Center, Johns Hopkins University, School of Medicine, Baltimore, MD, United States, 3 Istituto di Medicina Generale e Pneumologia, Cattedra di Malattie dell'Apparato Respiratorio, University of Palermo, Palermo, Italy

* To whom correspondence should be addressed. E-mail: atogias{at}jhmi.edu.

Deep inspiration-induced bronchoprotection and bronchodilation are impaired in asthma. We evaluated the effect of inhaled glucocorticosteroids on these phenomena. Nine asthmatics with moderate/severe and 12 with mild/borderline hyperresponsiveness to methacholine received inhaled fluticasone (880 µg daily) for 12 weeks. Serial bronchoprovocations were performed at weeks 0, 6 and 12. The impact of deep inspirations on the airway response to methacholine was evaluated using inspiratory vital capacity and FEV1. Fluticasone produced a wide spectrum of changes in the beneficial effects of deep inspiration, but the mean changes were not significant. The magnitude of the steroid-induced changes in bronchoprotection by deep inspiration correlated with baseline logPC20 (higher logPC20 predicted improvement of the deep inspiration effect). The steroid-induced changes led to the emergence of strong positive correlations between the effects of deep inspiration and the methacholine logPC20 that did not exist at baseline. We conclude that deep inspiration-induced bronchoprotection can be restored by inhaled glucocorticosteroids only in individuals with mild hyperresponsiveness. After steroid treatment, the beneficial effects of deep inspiration become significant determinants of the magnitude of airways hyperresponsiveness.
Key words: deep inspiration, asthma, airway hyperresponsiveness, fluticasone, methacholine




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