Inhaled corticosteroids moderate lung function decline in adults with asthma

Inhaled corticosteroids are the mainstay of asthma treatment. They have earned this central place in our therapeutic armamentarium by their rapid alleviation of persistent asthma symptoms, improvement in lung function, prevention of exacerbations including those severe enough to require hospitalisation, and by preventing asthma deaths, even at low doses.1,2 They appear indicated as maintenance therapy for asthma patients who have more than occasional respiratory symptoms,3 and probably need to be used regularly to provide benefit.4 A recent study suggesting the contrary used a protocol of initial intense treatment with inhaled and oral corticosteroids which is not readily applicable clinically.5

Patients with asthma have a more rapid decline in lung function over time which results in significant irreversible airways obstruction in a substantial minority (estimates range from 23% to 33%).6–9 Such fixed airflow limitation in asthma appears to be a manifestation of airway remodelling.10 While corticosteroids have many actions which might be expected to limit such remodelling, there is no …