RT Journal Article
SR Electronic
T1 Targeting dynamic hyperinflation in moderate-to-severe asthma: a randomised controlled trial
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00738-2020
DO 10.1183/23120541.00738-2020
VO 7
IS 3
A1 Akke-Nynke van der Meer
A1 Kim de Jong
A1 Aranka Hoekstra-Kuik
A1 Elisabeth H. Bel
A1 Anneke ten Brinke
YR 2021
UL http://openres.ersjournals.com/content/7/3/00738-2020.abstract
AB Background Dynamic hyperinflation is highly prevalent in moderate-to-severe asthma, which may significantly impede activities of daily life. We hypothesised that dynamic hyperinflation 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 dynamic hyperinflation in moderate-to-severe asthma patients and explored the relationships between inflammatory markers and changes in dynamic hyperinflation.Methods In this randomised placebo-controlled trial we included 32 asthma patients on inhaled glucocorticoid therapy showing dynamic hyperinflation, 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 dynamic hyperinflation testing.Results After adjustment for potential confounders, dynamic hyperinflation 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 dynamic hyperinflation 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.Dynamic hyperinflation: a target for treatment in asthma, which can be reduced by systemic anti-inflammatory treatment https://bit.ly/3gfyxYv