Invited Speaker

Anti-Inflammatory Therapy and Decline of Lung Function in Patients with Asthma
Charlotte Suppli Ulrik
Denmark


In spite of major advances in our understanding of asthma in recent years, many questions remain largely unanswered, not least when it comes to factors having impact on lung function decline in patients with asthma.

Inhaled corticosteroids is the cornerstone of asthma therapy, due to their rapid effect on symptoms, improvement in lung function, prevention of severe asthma-related events, and prevention of asthma deaths.

Previous studies have clearly shown that patients with asthma have a more rapid decline in lung function over time compared to individuals with no respiratory disorder, and in some patients with asthma, possibly more than 25%, this leads to non-reversible airflow obstruction, which is most likely a manifestation of airway remodelling.

Based on the mechanism of action, inhaled corticosteroids might be expected to reduce the degree of airway remodelling, but so far no general consensus has been reached with regard to their efficacy in real life.

Studies from recent years have shown that regular treatment with inhaled corticosteroids reduce the annual decline of lung function in adults suffering from asthma, and probably not least if used earlier in the course of the disease. However, an important limitation is that these observations do not come from controlled clinical trials.

Current knowledge from observational studies provides strong evidence that regular treatment with inhaled corticosteroids favourably alters the natural history of asthma, and stronger evidence is unlikely to be obtained due to the ethical implications of withholding inhaled corticosteroids for several years in a randomised controlled trial.