Responsiveness to Parenteral Corticosteroids and Lung Function Trajectory in Adults with Moderate-to-Severe Asthma
dc.contributor.author | Denlinger, Loren C. | |
dc.contributor.author | Phillips, Brenda R. | |
dc.contributor.author | Sorkness, Ronald L. | |
dc.contributor.author | Bleecker, Eugene R. | |
dc.contributor.author | Castro, Mario | |
dc.contributor.author | DeBoer, Mark D. | |
dc.contributor.author | Fitzpatrick, Anne M. | |
dc.contributor.author | Hastie, Annette T. | |
dc.contributor.author | Gaffin, Jonathan M. | |
dc.contributor.author | Moore, Wendy C. | |
dc.contributor.author | Peters, Michael C. | |
dc.contributor.author | Peters, Stephen P. | |
dc.contributor.author | Phipatanakul, Wanda | |
dc.contributor.author | Cardet, Juan Carlos | |
dc.contributor.author | Erzurum, Serpil C. | |
dc.contributor.author | Fahy, John V. | |
dc.contributor.author | Fajt, Merritt L. | |
dc.contributor.author | Gaston, Benjamin | |
dc.contributor.author | Levy, Bruce D. | |
dc.contributor.author | Meyers, Deborah A. | |
dc.contributor.author | Ross, Kristie | |
dc.contributor.author | Teague, W. Gerald | |
dc.contributor.author | Wenzel, Sally E. | |
dc.contributor.author | Woodruff, Prescott G. | |
dc.contributor.author | Zein, Joe | |
dc.contributor.author | Jarjour, Nizar N. | |
dc.contributor.author | Mauger, David T. | |
dc.contributor.author | Israel, Elliot | |
dc.contributor.department | Pediatrics, School of Medicine | |
dc.date.accessioned | 2024-03-21T13:00:36Z | |
dc.date.available | 2024-03-21T13:00:36Z | |
dc.date.issued | 2021 | |
dc.description.abstract | Rationale: It is unclear why select patients with moderate-to-severe asthma continue to lose lung function despite therapy. We hypothesized that participants with the smallest responses to parenteral corticosteroids have the greatest risk of undergoing a severe decline in lung function. Objectives: To evaluate corticosteroid-response phenotypes as longitudinal predictors of lung decline. Methods: Adults within the NHLBI SARP III (Severe Asthma Research Program III) who had undergone a course of intramuscular triamcinolone at baseline and at ≥2 annual follow-up visits were evaluated. Longitudinal slopes were calculated for each participant’s post-bronchodilator FEV1% predicted. Categories of participant FEV1 slope were defined: severe decline, >2% loss/yr; mild decline, >0.5–2.0% loss/yr; no change, 0.5% loss/yr to <1% gain/yr; and improvement, ≥1% gain/yr. Regression models were used to develop predictors of severe decline. Measurements and Main Results: Of 396 participants, 78 had severe decline, 91 had mild decline, 114 had no change, and 113 showed improvement. The triamcinolone-induced difference in the post-bronchodilator FEV1% predicted (derived by baseline subtraction) was related to the 4-year change in lung function or slope category in univariable models (P < 0.001). For each 5% decrement in the triamcinolone-induced difference the FEV1% predicted, there was a 50% increase in the odds of being in the severe decline group (odds ratio, 1.5; 95% confidence interval, 1.3–1.8), when adjusted for baseline FEV1, exacerbation history, blood eosinophils and body mass index. Conclusions: Failure to improve the post-bronchodilator FEV1 after a challenge with parenteral corticosteroids is an evoked biomarker for patients at risk for a severe decline in lung function. | |
dc.eprint.version | Final published version | |
dc.identifier.citation | Denlinger LC, Phillips BR, Sorkness RL, et al. Responsiveness to Parenteral Corticosteroids and Lung Function Trajectory in Adults with Moderate-to-Severe Asthma. Am J Respir Crit Care Med. 2021;203(7):841-852. doi:10.1164/rccm.202002-0454OC | |
dc.identifier.uri | https://hdl.handle.net/1805/39388 | |
dc.language.iso | en_US | |
dc.publisher | American Thoracic Society | |
dc.relation.isversionof | 10.1164/rccm.202002-0454OC | |
dc.relation.journal | American Journal of Respiratory and Critical Care Medicine | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Severe asthma | |
dc.subject | Corticosteroid sensitivity | |
dc.subject | Longitudinal | |
dc.subject | Lung function | |
dc.subject | Exacerbations | |
dc.title | Responsiveness to Parenteral Corticosteroids and Lung Function Trajectory in Adults with Moderate-to-Severe Asthma | |
dc.type | Article | |
ul.alternative.fulltext | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017577/ |
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