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Step‐down of inhaled corticosteroids in non‐eosinophilic asthma: A prospective trial in real life

机译：在非嗜酸性哮喘中吸入皮质类固醇的降雨：现实生活中的前瞻性试验

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Summary Background While non‐eosinophilic asthmatics are usually considered poorly responsive to inhaled corticosteroids ( ICS s), studies assessing a step‐down of ICS in this specific population are currently lacking. Objectives To assess the proportion of non‐eosinophilic asthmatics in whom ICS may be withdrawn without any clinical degradation and to determine the predictive markers of a failure to stop treatment with ICS . Methods This prospective study was completed by 36 non‐eosinophilic asthmatics, defined by sputum eosinophils 3% and blood eosinophils 400/μL. In these patients, whichever the baseline asthma control level, the dose of ICS was gradually reduced every 3?months until they met the failure criteria or successfully discontinued ICS for 6?months. The failure criteria were an ACQ score ≥1.5 with an increase from baseline 0.5 or a number of severe exacerbations during the study which was greater than the number during the year prior to the baseline visit. Receiver‐operating characteristic ( ROC ) curves were constructed to assess predictors of a failure to stop ICS . This study is registered with ClinicalTrials.gov, number NCT 02169323. Results In 14 patients (39%), ICS s were completely withdrawn, and in 10 further patients (28%), ICS were stepped‐down to a reduced ICS dose without any deterioration of asthma control and exacerbation rate. Baseline predictors of a failure to stop ICS were a greater age (area under ROC curve [ ROC AUC ] and [95% CI ]: 0.77 [0.62‐0.93]) and elevated blood eosinophils ( ROC AUC [95% CI ]: 0.77 [0.61‐0.93]). After the first step‐down of ICS , the best predictor was an elevated blood eosinophil count ( ROC AUC [95% CI ]: 0.85 [0.72‐0.99]). Conclusions & Clinical Relevance Withdrawing or reducing the dose of ICS is feasible in two‐thirds of non‐eosinophilic asthmatics irrespective of baseline asthma control. An elevated blood eosinophil count may predict the failure to stop ICS .
机译：发明内容背景虽然非嗜酸性嗜型哮喘患者响应于吸入皮质类固醇（ICS）的敏感性较差，但目前缺乏评估该特定人群IC的降压的研究。目的，评估ICS的非嗜酸性哮喘症的比例可以在没有任何临床劣化的情况下撤回，并确定失败的预测标志物，无法用IC停止治疗。方法该前瞻性研究由36种非嗜酸性哮喘学完成，由痰嗜酸性粒细胞定义。3％和血液粒细胞<400 /μL。在这些患者中，无论哪种患者，无论哪种基线哮喘控制水平，IC的剂量每3个月逐渐减少，直到他们达到失败标准或成功停产6？几个月。失败标准是ACQ评分≥1.5，随着基线＆gt增加，在研究期间增加0.5或若干严重恶化，大于基线访问前一年中的数量。构建接收器操作特征（ROC）曲线以评估失败的预测因子来停止IC。本研究在ClinicalTrials.gov注册，NCT 02169323。结果14名患者（39％），ICS S完全撤回，并在10名患者（28％）中，逐步降低ICS减少的IC剂量哮喘控制和加剧率的恶化。失败的基线预测因子IC是更大的年龄（ROC曲线[ROC AUC]和[95％CI]的区域：0.77 [0.62-0.93]）和血嗜酸性粒细胞升高（ROC AUC [95％CI]：0.77 [ 0.61-0.93]）。在IC的第一次下降之后，最佳预测因子是血液嗜酸血粒细胞计数升高（ROC AUC [95％CI]：0.85 [0.72-0.99]）。结论＆amp;无论基线哮喘控制如何，临床相关性退出或减少IC的剂量是可行的，其非嗜酸性哮喘无关。血液嗜酸血粒细胞计数升高可能预测阻止IC的失败。

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