Chest
Volume 120, Issue 3, September 2001, Pages 770-777
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Clinical Investigations
Asthma
Do Inhaled Corticosteroids Affect Perception of Dyspnea During Bronchoconstriction in Asthma?

https://doi.org/10.1378/chest.120.3.770Get rights and content

Abstract

Background

Some of the disagreements on the perception of dyspnea (PD) during bronchoconstriction in asthma patients could depend on the interrelationships among the following: (1) the influence of baseline airflow obstruction on the patient’s ability to detect any further increase in airway resistance; (2) the effect of eosinophilic inflammation on the airway; (3) bronchial hyperresponsiveness (BHR); and (4) the effect of inhaled corticosteroids (ICSs).

Objective

We hypothesized that if the inflammation of the airway wall influences to some extent and in some way the PD in asthma patients, ICSs reverse the effect of airway inflammation on the PD.

Methods

We studied 100 asthma patients who were divided into the following four groups: patients with obstruction who were either ICS-naive (group I) or were treated with ICSs (group II); and nonobstructed patients who were either ICS-naive (group III) or were treated with ICSs (group IV). PD on the visual analog scale (VAS) was assessed during a methacholine-induced FEV1 decrease and specifically was quantified as the VAS slope and score at an FEV1 decrease of 5 to 20%. BHR was assessed in terms of the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20). Eosinophil counts in induced sputum samples also were performed. Regression analysis, univariate analysis of variance, and factor analysis were applied for statistical evaluation.

Results

For a 5 to 20% fall in FEV1 from the lowest point after saline solution induction, VAS score was lowest in group II, slightly higher in group I, slightly higher still in group IV, and the highest in group III. In the patients as a whole, BHR related to PD, but age, clinical score, duration of the disease, and presence of baseline airway obstruction did not. In patients with obstruction who were treated with ICSs, eosinophil counts related to PD negatively. Factor analysis yielded the following four factors that accounted for 70% of the variance in the data: ICS; eosinophil counts; FEV1; and PC20 loaded on separated factors with PD loading on the same factors as PC20. The post hoc analysis carried out dividing the patients into ICS-treated and ICS-naive, showed that in the former group eosinophil counts and BHR proved to be factors negatively associated with PD, while in the latter group eosinophil counts were positively associated with PD.

Conclusions

We have shown that eosinophilic inflammation of the airway wall may increase PD and that the association of eosinophil counts with ICSs may result in lessening the PD.

Section snippets

Patients

One hundred asthma patients (65 women) aged 16 to 75 years (mean age, 41.5 years) diagnosed with bronchial asthma according to the criteria of the National Heart, Lung, and Blood Institute16 participated in the study. In all patients, asthma was stable and persistent, and it was classified as either mild or mild to moderate according to the frequency of symptoms, the requirement of β2-agonists for the treatment of symptoms, baseline airway function, BHR, and a provocative concentration of

Results

Anthropometric, clinical, baseline function, and sputum data of the four groups of patients are listed in Table 1, Table 2. Groups were matched (χ2 analysis) for age, gender, atopy, and clinical score. Groups I and III also were matched for duration of the disease, and groups II and IV were matched for duration of the disease and the daily dosage of ICSs. In groups II and IV, the duration of the disease was significantly higher than that in groups I and III.

References (36)

  • CM Law et al.

    Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate

    Lancet

    (1986)
  • JC Schraa et al.

    The influence of corticosteroids and theophylline on cerebral function: a review

    Chest

    (1982)
  • HI Manning et al.

    Pathophysiology of dyspnea

    N Engl J Med

    (1995)
  • G Scano et al.

    Dyspnea, peripheral airway involvement and respiratory muscle effort in patients with type I diabetes mellitus in good metabolic control

    Clin Sci

    (1999)
  • MD Lougheed et al.

    Breathlessness during acute bronchoconstriction in asthma: pathophysiologic mechanisms

    Am Rev Respir Dis

    (1993)
  • JGW Burdon et al.

    The perception of breathlessness in asthma

    Am Rev Respir Dis

    (1982)
  • R Ottanelli et al.

    Perception of breathlessness and bronchial hyperresponsiveness in asthma

    Clin Sci

    (2000)
  • DW Hudgel et al.

    Recognition of added resistive loads in asthma: the importance of behavioral styles

    Am Rev Respir Dis

    (1982)
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    This work was supported by grants from the Ministero dell’Università e della Ricerca Scientifica e Tecnologica, Italy, and by the Fondazione Don C. Gnocchi IRCCS.

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