PT  - JOURNAL ARTICLE
AU  - A. N. van der Meer
AU  - K. de Jong
AU  - A. Hoekstra-Kuik
AU  - E. H. Bel
AU  - A. ten Brinke
TI  - Targeting dynamic hyperinflation in moderate to severe asthma – a randomised controlled trial
AID  - 10.1183/23120541.00738-2020
DP  - 2021 Jan 01
TA  - ERJ Open Research
PG  - 00738-2020
4099  - http://openres.ersjournals.com/content/early/2021/05/27/23120541.00738-2020.short
4100  - http://openres.ersjournals.com/content/early/2021/05/27/23120541.00738-2020.full
AB  - Background Dynamic hyperinflation (DH) is highly prevalent in moderate to severe asthma, which may significantly impede activities of daily life. We hypothesised that DH in asthma is due to inflammation of large and small airways and can be reduced by systemic anti-inflammatory treatment. Therefore, we investigated the effect of systemic glucocorticoids on DH in moderate to severe asthma patients and explored the relationships between inflammatory markers and changes in DH.Methods In this randomised placebo-controlled trial we included 32 asthma patients on inhaled glucocorticoid therapy showing DH, defined by a ≥10% reduction in inspiratory capacity measured by standardised metronome-paced tachypnea test. Patients received either triamcinolone (80 mg) or placebo intramuscularly. Before and 2 weeks after treatment, patients completed respiratory health questionnaires, had blood eosinophils and exhaled nitric oxide levels measured and underwent lung function and DH testing.Results After adjustment for potential confounders, DH was significantly reduced by 28.1% in the triamcinolone group, and increased by 9.4% in the placebo group (p=0.027). In the triamcinolone-treated patients, the reduction in DH was greater in patients with higher blood eosinophils at baseline (r=−0.592, p=0.020) and tended to be associated with a reduction in blood eosinophils (r=0.412, p=0.127) and exhaled nitric oxide (r=0.442, p=0.099).Conclusions This exploratory study suggests that dynamic hyperinflation in asthma can be reduced by systemic anti-inflammatory treatment, particularly in patients with elevated blood eosinophils. This supports the hypothesis that dynamic hyperinflation in asthma is due to airway inflammation and should be considered an important target for treatment.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: A.N. van der Meer reports grants from Medical Centre Leeuwarden Research Fund, unrestricted grants from TEVA and GSK, and grants from Stichting Longgeneeskunde Fryslan, during the conduct of the study.Conflict of interest: Dr. de Jong has nothing to disclose.Conflict of interest: Dr. Hoekstra-Kuik has nothing to disclose.Conflict of interest: Dr. Bel reports grants and personal fees from AstraZeneca, grants and personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from Teva, personal fees from Sanofi/Regeneron, personal fees from Sterna, personal fees from Chiesi, outside the submitted work; .Dr. Bel reports grants and personal fees from AstraZeneca, grants and personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from Teva, personal fees from Sanofi/Regeneron, personal fees from Sterna, personal fees from Chiesi, outside the submitted work; .Conflict of interest: A. ten Brinke reports grants from Medical Centre Leeuwarden Research Fund, unrestricted research grants from TEVA and GSK, and grants from Stichting Longgeneeskunde Fryslan, during the conduct of the study; and institutional fees for research advisory boards from GSK, Sanofi, TEVA, AstraZeneca, and Boehringer Ingelheim, and institutional fees for lectures from GSK, TEVA and AstraZeneca, all outside the submitted work.