Background

Although inhaled corticosteroids (ICSs) are the recommended first-line therapy for asthma, determining whether to continue or discontinue ICS treatment in patients with mild asthma remains challenging for clinicians. Several studies have revealed that patients with mild-persistent asthma maintained a well-controlled state after ICS withdrawal. However, the long-term outcomes of ICS withdrawal have not yet been determined.

Objective

To determine the possible clinical outcomes of the discontinuation of ICS in patients with well-controlled mild asthma.

Methods

We investigated the clinical outcomes of discontinuing ICSs in patients with well-controlled mild asthma and compared the time to loss of control (LOC) between patients who stopped ICS treatment (ICS withdrawal group, IWG) and those who continued treatment for 3 years (continuous ICS group, CIG).

Results

A significant difference in the time to LOC was observed between the IWG and CIG (hazard ratio, 2.56; 95% confidence interval, 1.52-4.33; P < .001). Increasing fractional exhaled nitric oxide levels (P = 0.008) and sputum eosinophil counts (%) (P = 0.015) revealed a weak but significant association with LOC risk in the CIG. The sputum eosinophil counts (P = 0.039) and serum total immunoglobulin E levels (P = 0.014) were significantly higher in the LOC group than in the non-LOC group of the CIG.

Conclusion

Our results suggest that the maintenance of ICS treatment may help keep patients’ asthma under control. Furthermore, patients with LOC had significantly higher sputum eosinophil counts in the CIG than those in the non-LOC group. Therefore, continuous ICS use by patients with mild, well-controlled asthma could be associated with good clinical outcomes.

Trial Registration

ClinicalTrials.gov Identifier: KCT0002234.

中文翻译：

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哮喘控制患者停用吸入性皮质类固醇

背景

尽管吸入性皮质类固醇 (ICS) 是推荐的哮喘一线治疗方法，但对于临床医生来说，确定是继续还是停止 ICS 治疗轻度哮喘患者仍然具有挑战性。多项研究表明，轻度持续性哮喘患者在停用 ICS 后仍保持良好的控制状态。然而，ICS 退出的长期结果尚未确定。

客观的

确定在控制良好的轻度哮喘患者中停止 ICS 的可能临床结果。

方法

我们调查了控制良好的轻度哮喘患者停用 ICS 的临床结局，并比较了停止 ICS 治疗的患者（ICS 戒断组，IWG）和继续治疗 3 年（持续治疗）的患者之间的失控时间（LOC）。 ICS 组，CIG）。

结果

在 IWG 和 CIG 之间观察到 LOC 时间的显着差异（风险比，2.56；95% 置信区间，1.52-4.33；P < .001）。呼出气一氧化氮水平 ( P = 0.008) 和痰嗜酸性粒细胞计数 (%) ( P = 0.015) 的增加表明与 CIG 中的 LOC 风险存在微弱但显着的关联。LOC组的痰嗜酸性粒细胞计数（P = 0.039）和血清总免疫球蛋白E水平（P = 0.014）显着高于CIG的非LOC组。

结论

我们的结果表明，维持 ICS 治疗可能有助于控制患者的哮喘。此外，LOC 患者在 CIG 中的痰嗜酸性粒细胞计数显着高于非 LOC 组。因此，轻度、控制良好的哮喘患者持续使用 ICS 可能与良好的临床结果相关。

试用注册

ClinicalTrials.gov 标识符：KCT0002234。