Asthma remission: Does it exist?

Current Opinion in Pulmonary Medicine

Volumn 9, Issue 1, 2003, Pages 15-20

  Van den Toorn, Leon M ^a   Overbeek, Shelley E ^a   Prins, Jan Bas ^a   Hoogsteden, Henk C ^a   De Jongste, Johan C ^a  

^a ERASMUS MEDICAL CENTER   (Netherlands)

Author keywords

[No Author keywords available]

Indexed keywords

METHACHOLINE;

AIRWAY OBSTRUCTION; ALLERGIC ASTHMA; ANAMNESIS; ASTHMA; BRONCHUS BIOPSY; CHILDHOOD DISEASE; CHRONIC INFLAMMATION; EPIDEMIOLOGICAL DATA; HUMAN; INFLAMMATION; PROGNOSIS; RELAPSE; REMISSION; REVIEW; SYMPTOM;

ADOLESCENT; ADULT; ASTHMA; BASEMENT MEMBRANE; BIOPSY, NEEDLE; BRONCHI; BRONCHIAL HYPERREACTIVITY; BRONCHOALVEOLAR LAVAGE FLUID; CHILD; FEMALE; HUMANS; INFLAMMATION; MALE; MIDDLE AGED; PROGNOSIS; RECOVERY OF FUNCTION; REMISSION, SPONTANEOUS; RESPIRATORY FUNCTION TESTS; RESPIRATORY MUCOSA; RISK ASSESSMENT; SENSITIVITY AND SPECIFICITY;

EID: 0037212609     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-200301000-00003     Document Type: Review

References (64)

1. Barbee RA, Murphy S: The natural history of asthma. J Allergy Clin Immunol 1998, 102:S65-72.
2. Martin AJ, McLennan LA, Landau LI, Phelan PD. The natural history of childhood asthma to adult life. Br Med J 1980, 280:1397-1400.
3. Panhuysen CI, Vonk JM, Koeter GH, et al.: Adult patients may outgrow their asthma: A 25-year follow-up study. Am J Respir Crit Care Med 1997, 155:1267-72.
4. Martinez FD. Links between pediatric and adult asthma. J Allergy Clin Immunol 2001, 107(suppl 5):449S-455S.
5. Fahy JV, Corry DB, Boushey HA: Airway inflammation and remodeling in asthma. Curr Opin Pulm Med 2000, 6:15-20.
6. Vignola AM, Chanez P, Bonsignore G, et al.: Structural consequences of airway inflammation in asthma. J Allergy Clin Immunol 2000, 105:514-517.
7. Van den Toorn LM, Overbeek SE, De Jongste JC, et al.: Airway inflammation is present during clinical remission of atopic asthma. Am J Respir Crit Care Med 2001, 164:2107-2113.
8. Warke TJ, Fitch PS, Brown V, et al.: Outgrown asthma does not mean no airways inflammation. Eur Respir J 2002, 19:284-287. The hypothesis of this study was that children who seemed to have grown out of asthma would show ongoing airway inflammation. BAL was performed on 35 healthy children, 10 children with outgrown viral wheeze, and 25 children with outgrown asthma. Eosinophils were increased in the BAL fluid of children who had apparently grown out of asthma (median (interquartile range) 0.36 (0.05-0.74) compared with controls 0.10 (0-0.18), P = 0.002). No relation between length of remission and degree of airways eosinophilia could be demonstrated. It was supposed by the authors that persistent airway inflammation enhances the risk on later relapse.
9. Kerrebijn KF, Fioole AC, van Bentveld RD: Lung function in asthmatic children after year or more without symptoms or treatment. Br Med J 1978, 1:886-888.
10. Boulet LP, Turcotte H, Brochu A: Persistence of airway obstruction and hyperresponsiveness in subjects with asthma remission. Chest 1994, 105:1024-1031.
11. Vignola AM, Gagliardo R, Siena A, et al.: Airway remodeling in the pathogenesis of asthma. Curr Allergy Asthma Rep 2001, 1:108-115.
12. Cokugras H, Akcakaya N, Seckin Y, et al.: Ultrastructural examination of bronchial biopsy specimens from children with moderate asthma. Thorax 2001, 56:25-29. The aim of this study was to assess histopathologic changes in the bronchi of young children with moderate asthma with the aid of light and electron microscopy. Bronchial biopsy specimens from 10 children with moderate asthma age 9.3±3.8 (mean ± SD) years were examined. The most important finding was thickening of the basement membrane in nine patients. It was concluded that also very young children with moderate asthma already show airway remodeling.
13. Page S, Ammit AJ, Black JL, Armour CL: Human mast cell and airway smooth muscle cell interactions: Implications for asthma. Am J Physiol Lung Cell Mol Physiol 2001, 281:L1313-L1323.
14. Rossi GL, Olivieri D: Does the mast cell still have a key role in asthma? Chest 1997, 112:523-529.
15. Sommerhoff CP: Mast cell tryptases and airway remodeling. Am J Respir Crit Care Med 2001, 164:S52-S58.
16. Fahy JV, Wong H, Liu J, Boushey HA: Comparison of samples collected by sputum induction and bronchoscopy from asthmatic and healthy subjects. Am J Respir Crit Care Med 1995, 152:53-58.
17. Grootendorst DC, Sont JK, Willems LN, et al.: Comparison of inflammatory cell counts in asthma: Induced sputum vs. bronchoalveolar lavage and bronchial biopsies. Clin Exp Allergy 1997, 27:769-779.
18. 1 (PR 0.97, 95% Cl: 0.96;0.99). It was concluded that BHR to AMP refers to inflammatory aspects and airway "lability", whereas BHR to MCh was related to a diminished airway caliber.
19. Polosa, R., S. Rorke, and S. T. Holgate. 2002. Evolving concepts on the value of adenosine hyperresponsiveness in asthma and chronic obstructive pulmonary disease. Thorax 57(7):649-654.
20. 1% predicted. It was concluded that PC20 AMP is more sensitive to changes in acute airway inflammation than is PC20 MCh.
21. Van Velzen E, van den Bos JW, Benckhuijsen JA, et al.: Effect of allergen avoidance at high altitude on direct and indirect bronchial hyperresponsiveness and markers of inflammation in children with allergic asthma. Thorax 1996, 51:582-584.
22. Benckhuijsen J, van den Bos JW, van Velzen E, et al.: Differences in the effect of allergen avoidance on bronchial hyperresponsiveness as measured by methacholine, adenosine 5′-monophosphate, and exercise in asthmatic children. Pediatr Pulmonol 1996, 22:147-153.
23. O'Connor BJ, Ridge SM, Barnes PJ, Fuller RW: Greater effect of inhaled budesonide on adenosine 5′-monophosphate-induced than on sodium-metabisulfite-induced bronchoconstriction in asthma. Am Rev Respir Dis 1992, 146:560-564.
24. Taylor DA, Jensen MW, Kanabar V, et al.: A dose-dependent effect of the novel inhaled corticosteroid ciclesonide on airway responsiveness to adenosine-5′-monophosphate in asthmatic patients. Am J Respir Crit Care Med 1999, 160:237-243.
25. Van den Berge M, Kerstjens HA, Meijer RJ, et al.: Corticosteroid-induced improvement in the PC20 of adenosine monophosphate is more closely associated with reduction in airway inflammation than improvement in the PC20 of methacholine. Am J Respir Crit Care Med 2001, 164:1127-1132.
26. Sont JK, Han J, van Krieken JM, et al.: Relation between the inflammatory infiltrate in bronchial biopsy specimens and clinical severity of asthma in patients treated with inhaled steroids. Thorax 1996, 51:496-502.
27. Crimi E, Spanevello A, Neri M, et al.: Dissociation between airway inflammation and airway hyperresponsiveness in allergic asthma. Am J Respir Crit Care Med 1998, 157:4-9.
28. Chetta A, Foresi A, Del Donno M, et al.: Bronchial responsiveness to distilled water and methacholine and its relation to inflammation and remodeling of the airways in asthma. Am J Respir Crit Care Med 1996, 153:910-917.
29. Laprise C, Laviolette M, Boutet M, Boulet LP: Asymptomatic airway hyperresponsiveness: Relationships with airway inflammation and remodeling. Eur Respir J 1999, 14:63-73.
30. Ward C, Pais M, Bish R, et al.: Airway inflammation, basement membrane thickening and bronchial hyperresponsiveness in asthma. Thorax 2002, 57:309-316. In this study, the relationships between spirometry, airway inflammation, airway remodeling, and BHR were investigated in a group of 35 patients with mild asthma before and after treatment with inhaled fluticasone propionate (FP 750 μg bd). BAL and airway biopsy studies were carried out at baseline and after 3 and 12 months of treatment. Results were compared with those from twenty-two healthy subjects. One third of the improvement in BHR with FP was associated with initial changes in inflammation, but the more progressive and larger improvement was associated with the later improvement in airway remodeling. The authors concluded that physiology, airway inflammation and remodeling in asthma are interrelated and improve with ICS, but that prolonged treatment is necessary for maximal benefit in remodeling and PD(20).
31. Baraldi E, Carra S, Dario C, et al.: Effect of natural grass pollen exposure on exhaled nitric oxide in asthmatic children. Am J Respir Crit Care Med 1999, 159:262-266.
32. Kharitonov SA, BJ OC, Evans DJ, Barnes PJ: Allergen-induced late asthmatic reactions are associated with elevation of exhaled nitric oxide. Am J Respir Crit Care Med 1995, 151:1894-1899.
33. Piacentini GL, Bodini A, Costella S, et al.: Allergen avoidance is associated with a fall in exhaled nitric oxide in asthmatic children. J Allergy Clin Immunol 1999, 104:1323-1324.
34. Mattes J, Storm van's Gravesande K, Reining U, et al.: NO in exhaled air is correlated with markers of eosinophilic airway inflammation in corticosteroid-dependent childhood asthma. Eur Respir J 1999, 13:1391-1395.
35. Piacentini GL, Bodini A, Costella S, et al.: Exhaled nitric oxide and sputum eosinophil markers of inflammation in asthmatic children. Eur Respir J 1999, 13:1386-1390.
36. Silvestri M, Spallarossa D, Frangova Yourukova V, et al.: Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma. Eur Respir J 1999, 13:321-326.
37. Warke TJ, Fitch PS, Brown V, et al.: Exhaled nitric oxide correlates with airway eosinophils in childhood asthma. Thorax 2002, 57:383-387.
38. Payne DN, Adcock IM, Wilson NM, et al.: Relation between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med 2001, 164:1376-1381.
39. Colice GL: Categorizing asthma severity and monitoring control of chronic asthma. Curr Opin Pulm Med 2002, 8:4-8.
40. Jones SL, Kittelson J, Cowan JO, et al.: The predictive value of exhaled nitric oxide measurements in assessing changes in asthma control. Am J Respir Crit Care Med 2001, 164:738-743.
41. Teeter JG, Bleecker ER: Relation between airway obstruction and respiratory symptoms in adult asthmatics. Chest 1998, 113:272-277.
42. Veen JC, Smits HH, Ravensberg AJ, et al.: Impaired perception of dyspnea in patients with severe asthma. Relation to sputum eosinophils. Am J Respir Crit Care Med 1998, 158:1134-1141.
43. Bijl-Hofland ID, Cloosterman SG, Folgering HT, et al.: Relation of the perception of airway obstruction to the severity of asthma. Thorax 1999, 54:15-19.
44. Van den Toorn LM, Overbeek SE, Prins J-B, et al.: Dyspnea perception during clinical remission of atopic asthma. Thorax 2002, 19:1047-1050.
45. Osman LM, McKenzie L, Cairns J, et al.: Patient weighting of importance of asthma symptoms. Thorax 2001, 56:138-142.
46. Rietveld S, Everaerd W: Perceptions of asthma by adolescents at home. Chest 2000, 117:434-439.
47. Busse WW: Inflammation in asthma: The cornerstone of the disease and target of therapy. J Allergy Clin Immunol 1998, 102:S17-S22.
48. Jatakanon A, Lim S, Chung KF, Barnes PJ: An inhaled steroid improves markers of airway inflammation in patients with mild asthma. Eur Respir J 1998, 12:1084-1088.
49. Djukanovic R, Wilson JW, Britten KM, et al.: Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma. Am Rev Respir Dis 1992, 145:669-674.
50. Möller GM, Overbeek SE, Van Helden-Meeuwsen CG, et al.: Increased numbers of dendritic cells in the bronchial mucosa of atopic asthmatic patients: Downregulation by inhaled corticosteroids. Clin Exp Allergy 1996, 26:517-524.
51. Jatakanon A, Kharitonov S, Lim S, Barnes PJ: Effect of differing doses of inhaled budesonide on markers of airway inflammation in patients with mild asthma. Thorax 1999, 54:108-114.
52. van Rensen EL, Straathof KC, Veselic-Charvat MA, et al.: Effect of inhaled steroids on airway hyperresponsiveness, sputum eosinophils, and exhaled nitric oxide levels in patients with asthma. Thorax 1999, 54:403-408.
53. Kharitonov SA, Yates DH, Chung KF, Barnes PJ: Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients. Eur Respir J 1996, 9:196-201.
54. van Grunsven PM, van Schayck CP, Molema J, et al.: Effect of inhaled corticosteroids on bronchial responsiveness in patients with "corticosteroid naive" mild asthma: A meta-analysis. Thorax 1999, 54:316-322.
55. Vanacker NJ, Palmans E, Kips JC, Pauwels RA: Fluticasone inhibits but does not reverse allergen-induced structural airway changes. Am J Respir Crit Care Med 2001, 163:674-679.
56. Hoshino M, Takahashi M, Takai Y, Sim J: Inhaled corticosteroids decrease subepithelial collagen deposition by modulation of the balance between matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 expression in asthma. J Allergy Clin Immunol 1999, 104:356-363.
57. Grol MH, Gerritsen J, Vonk JM, et al.: Risk factors for growth and decline of lung function in asthmatic individuals up to age 42 years. A 30-year follow-up study. Am J Respir Crit Care Med 1999, 160:1830-1837.
58. Ulrik CS: Outcome of asthma: Longitudinal changes in lung function. Eur Respir J 1999, 13:904-918.
59. Suissa S, Ernst P, Benayoun S, et al.: Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000, 343:332-336.
60. Lange P: Prognosis of adult asthma. Monaldi Arch Chest Dis 1999, 54:350-352.
61. Koh YY, Sun YH, Lim HS, et al.: Effect of inhaled budesonide on bronchial hyperresponsiveness in adolescents with clinical remission of asthma. Chest 2001, 120:1140-1146. The aim of this study was to determine whether BHR in adolescents with asthma remission could be reduced by prolonged treatment with inhaled corticosteroids. Thirty-seven adolescents with BHR and long-term clinical remission of their asthma received inhaled budesonide (two 200-microg puffs bid; budesonide group, n = 19) or placebo (placebo group, n = 18) for 9 months. In neither the placebo nor the budesonide group did the geometric mean of PC(20) methacholine change significantly over the 9-month period. The authors suggested that the mechanism underlying BHR in this clinical setting may be different from that in symptomatic asthma.
62. de Kluijver J, Evertse CE, Schrumpf JA, et al.: Asymptomatic worsening of airway inflammation during low-dose allergen exposure in asthma: Protection by Inhaled Steroids. Am J Respir Crit Care Med 2002, 166:294-300. In this study it was investigated whether "silent" allergen exposure induces and maintains airway inflammation and whether this can be prevented with inhaled steroids. Twenty-six atopic asthmatic patients inhaled low-dose allergen on 10 subsequent days. They were treated with 400 μg budesonide once daily (n = 13) or placebo (n = 13) from days -3 to 19. In the placebo group, allergen exposure resulted in a significant increase in sputum eosinophils (P = 0.043), ECP (P = 0.011), IL-5/IFN-γ messenger RNA ratio (P = 0.04), and eNO (P = 0.001), without worsening of symptoms and spirometry values. In the budesonide group, the changes in PC20, sputum ECP, and exhaled NO were significantly reduced as compared with changes in the placebo group (P < 0.03). The authors suggested that antiinflammatory therapy is beneficial during allergen exposure, even during asymptomatic episodes.
63. Bahceciler NN, Barlan IB, Nuhoglu Y, Basaran MM: Which factors predict success after discontinuation of inhaled budesonide therapy in children with asthma? J Asthma 2002, 39:37-46. In this study, urinary eosinophil protein X (UEPX) concentration, lung function, and BHR were determined in 40 asymptomatic asthmatic children treated with inhaled budesonide, to establish whether measurement of these parameters is useful in determining discontinuation of therapy. It was shown that duration of clinical remission was a more useful criterion than measurement of UEPX levels, lung function test, and assessment of BHR.
64. Sont JK, Willems LN, Bel EH, et al.: Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. Am J Respir Crit Care Med 1999, 159:1043-1051.