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Does early intervention with ICS improve long-term outcomes in asthma? PowerPoint PPT Presentation


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Does early intervention with ICS improve long-term outcomes in asthma?. Dr. Haluk Türktaş Gazi University Department of Pulmonary Medicine Ankara. Less risk of severe asthma exacerbation Fewer course of systemic corticosteroids More symptom free days Fewer urgent care visit

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Does early intervention with ICS improve long-term outcomes in asthma?

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Does early intervention with ics improve long term outcomes in asthma

Does early intervention with ICS improve

long-term outcomes in asthma?

Dr. Haluk Türktaş

Gazi University

Department of Pulmonary Medicine

Ankara


Does early intervention with ics improve long term outcomes in asthma

  • Less risk of severe asthma exacerbation

  • Fewer course of systemic corticosteroids

  • More symptom free days

  • Fewer urgent care visit

  • Less hospitalisation

  • Better pulmonary function tests

  • Better asthma control


Does early intervention with ics improve long term outcomes in asthma

Asthmatic Steroid-treated asthmatic


Does early intervention with ics improve long term outcomes in asthma

Does early intervention with ICS improve

long-term outcomes in asthma?


Does early intervention with ics improve long term outcomes in asthma

Rationale for early treatment intervention

  • Asthmatics experience progressive loss of lung function

  • Inflammation likely causes loss of lung function by remodelling

  • Inflammation has been documented in early asthma

  • Inflammation can occur without symptoms


Does early intervention with ics improve long term outcomes in asthma

50

40

30

20

10

0

140

120

100

80

60

40

20

0

Early ICS

Late ICS

PEF (L/min)

Changes in PEF (L/min)

First week Sixth week 12 th month Morning Evening Morning Evening Morning Evening

<6 mn 6-12 mn 1-2 yr 2-5 yr 5-10 yrl >10 yr

Symptom duration before treatment

Haahtela T N Engl J Med 1994; 331: 700

Selroos O Chest 1995: 108; 1228

EARLY INTERVENTION

WITH INHALER CORTICOSTEROIDS


Does early intervention with ics improve long term outcomes in asthma

Long-Term Effects of Budesonide or Nedocromil in Children with Asthma The Childhood Asthma Management Program Research Group (CAMP Study)

New Eng J Med 2000;343:1054-63

1041 children with mild to moderate asthma, 5-12 (8.9) years of age, treated 4-6 years.

Primary outcome post bronchodilator FEV1


Does early intervention with ics improve long term outcomes in asthma

Transient early

wheezing

Late onset

wheezing

Persistent

wheezing

Wheezing prevelance

0 3 6 11

Age (years)

Martinez F Eur Respir J 12:3s 1998


Does early intervention with ics improve long term outcomes in asthma

Outcome of Asthma and Wheezing in the First 6 Years of Life Follow-up through Adolescence

Wayne J. Morgan et al

Am J Respir Crit Care Med 2005;172:1253-1258


Does early intervention with ics improve long term outcomes in asthma

Long-term inhaled corticosteroids in preschool children at high risk for asthma (PEAK study)

Theresa W Guilbert et al, N Engl J Med2006;354:1985-97

nTarget childrenMean age(y)TreatmentDurationPrimary outcome

285 Positive asthma 3.0 FLU 100gx2 2 years Episode-free days during third

predictive index and per day year off study medication

>3 episode of wheeze last year


Does early intervention with ics improve long term outcomes in asthma

Intermittent inhaled corticosteroids in infants with episodic wheezing

(PAC study)

Hans Bisgaard et al, N Engl J Med2006;354:1998-2005

nTarget childrenMean age(y)TreatmentDurationPrimary outcome

294 Maternal asthma 1.7 2 week course 3 years Development of persistent

of budesonide wheezing during trial

400 g per day for each episode


Does early intervention with ics improve long term outcomes in asthma

  • Secondary prevention of asthma by the use of inhaled fluticasone in wheezy infants (IFWIN study)

  • Clare S Murray et all, Lancet2006;368:754-762

  • nTarget childrenMean age(y)TreatmentDurationPrimary outcome

  • Parental atopy and 0.9 FLU 100g twice Up to 4 years Lung function, BHR and

  • one prolonged or daily stepped down prevalence of doctor

  • two doctor confirmed diagnosed asthma

  • episode of wheezing

  • The groups did not differ significantly in

  • Physician diagnosed asthma

  • Lung function

  • Airway hyperreactivity


Does early intervention with ics improve long term outcomes in asthma

These early-asthma trials convincingly show that inhaled corticosteroids are only effective while being taken, and do not modify the natural course of the disease


Does early intervention with ics improve long term outcomes in asthma

X


Does early intervention with ics improve long term outcomes in asthma

Decline in Lung Function in the Busselton Health Study

The Effects of Asthma and Cigarette Smoking

Alan L. James et al Am J Respir Crit Care Med 2005;171:109-114


Does early intervention with ics improve long term outcomes in asthma

Asthma control and steroid doses 5 years after early or delayed introduction of inhaled corticosteroids in asthma: a real-life study

O. Selroos et al

Respir Med 2004;98:254-262

Early treatment group: symptoms for <2 years, n:253

Delayed treatment group: symptoms for >2 years, n: 51

Dose of inhaled steroids

% of predictive FEV1, PEF

Early treatment

Delayed treatment


Does early intervention with ics improve long term outcomes in asthma

Asthma control and steroid doses 5 years after early or delayed introduction of inhaled corticosteroids in asthma: a real-life study

O. Selroos et al

Respir Med 2004;98:254-262

Early treatment

Delayed treatment


Does early intervention with ics improve long term outcomes in asthma

Effects of Early Intervention With Inhaled Budesonide on Lung Function in Newly Diagnosed Asthma (START study)

Paul M. O’Byrne, Chest 2006;129:1478-1485

5-66 years old, 7165 patients, asthma duration<2 years,

3 years treatment with budesonide 400 g (200 g for children <11 years old)

-0.62%

-1.79%

-2.11%

-2.68%


Does early intervention with ics improve long term outcomes in asthma

Effects of Early Intervention With Inhaled Budesonide on Lung Function in Newly Diagnosed Asthma (START study)

Paul M. O’Byrne, Chest 2006;129:1478-1485

NS

NS

P<0.001


Does early intervention with ics improve long term outcomes in asthma

Inhaled corticosteroids and decline of lung function in community residents with asthma Peter Lange et al

Thorax 2006;61:100-104

1994-2003

With ICS (n:44)

Without ICS (n:190)

25 ml per year

P<0.001

P<0.001

51 ml per year

A 15-year follow-up study of ventilatory function in adults with asthma

Peter Lange et al (Copenhagen City Heart Study)

N Engl J Med 1998;339:1194-2000

1976-1994

1.7

1.5

1.3

1.1

0.9

0.7

0.5

0.3

No asthm a (n:16.441)

Asthma (n:1095)

FEV1 decline

Height-Adjusted FEV1 (litre)

22 ml per year

38 ml per year

20 30 40 50 60 70 80

Age (yr)


Does early intervention with ics improve long term outcomes in asthma

20.6 ml/yr

Lung function decline in asthma: association with inhaled corticosteroids, smoking and sex A Dijkstra et al

Thorax 2006;61:105-110

122 moderate to severe asthmatic patients diagnosed 1963-75 and re-eaxamined in 1991-99. Medain

follow up period of 23 years


Does early intervention with ics improve long term outcomes in asthma

Airway Inflammation Is Present during Clinical Remission of Atopic Asthma

Leon M Van Den Toorn et al

Am J Respir Crit Care Med 2001;164:2107-2113

Control

Remission


Does early intervention with ics improve long term outcomes in asthma

ICSs are associated with less disease burden

  • Less risk of severe asthma exacerbation

  • Fewer course of systemic corticosteroids

  • More symptom free days

  • Fewer urgent care visit

  • Less hospitalisation

  • Better pulmonary function tests

  • Better asthma control


Does early intervention with ics improve long term outcomes in asthma

2.5

2.0

1.5

1.0

0.5

0.0

5

4

3

2

1

0

100 million dose

Asthma mortaliy 1/100.000

1973 75 77 79 81 83 85 87 89 91 93

Years

2.5

2.0

1.5

1.0

0.5

0.0

Suissa S N Engl J Med 2000:343;332

Suissa S J Clin Epidemiol 1997:50;1079

Asthma mortality rate

0 1 2 3 4 5 6 7 8 9 10 11 12

Annual ICS use (box)

INHALER CORTICOSTEROIDS

AND ASTHMA MORTALITY


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