ROLE OF INHALED CORTICOSTEROIDS VERSUS SYSTEMIC CORTICOSTEROIDS IN THE MANAGEMENT OF ASTHMA
Main Article Content
Keywords
Inhaled Corticosteroids (ICS), Systemic Corticosteroids (SCS), Asthma, Asthma Control Test(ACT)
Abstract
Introduction: The aim of the current study was to analyze the comparison between the Inhaled Corticosteroids and Systemic Corticosteroids in the management of persistent asthma
Methods: In this study demographics analysis was conducted to examined the demographics characteristics of the participants. The descriptive analysis was conducted to examine the categorical variables. The difference between the lung functions test i.e., FEV1(Forced expiratory volume in the first second), FVC (Force vital capacity) and symptoms scores i.e., Asthma control test (ACT) between ICS(Inhaled corticosteroids) and SCS(systemic corticosteroid) groups was compared through t-test and chi-square test. While, multivariate analysis was used to examine the differences between the lung functions test i.e., FEV1, FVC and symptoms scores i.e., ACT between ICS and SCS groups when the potential cofounders were adjusted. Duration of asthma, severity, number of exacerbations in the past year, type of corticosteroid used (ICS or SCS), dosage, and duration of use, lung function tests (FEV1, FVC) and asthma control test (ACT) scores were analyzed through SPSS.
Results: The study found that after controlling for age, gender, BMI, and asthma duration, ICS was linked with significantly greater FEV1 compared to SCS (β coefficient = 0.28, p-value < 0.01). After adjusting for other covariates, the β coefficient for corticosteroid type (ICS vs. SCS) was 0.24, demonstrating a significant connection between ICS and greater FVC compared to SCS (p-value < 0.05). The β coefficient for corticosteroid type between ICS and SCS was 1.5, with a p-value < 0.01, indicating that patients on ICS had significantly higher ACT scores, indicating better asthma control. Longer asthma duration was a significant negative predictor (β = -0.2, p = 0.046), predicting poorer ACT scores. After controlling for relevant confounders, the multivariate analysis showed that ICS is linked with improved lung function (FEV1 and FVC) and asthma control (ACT scores) than SCS.
Conclusion: Exacerbations of persistent asthma are well treated with ICS. The best way to treat these individuals with ICS, how long they should take them for, and whether or not they should take systemic corticosteroids at the same time are all areas that need more investigation.
References
2. Cardet, J.C., A. Papi, and H.K. Reddel, “As-needed” inhaled corticosteroids for patients with asthma. The Journal of Allergy and Clinical Immunology: In Practice, 2023. 11(3): p. 726-734.
3. Haughney, J., et al., A charter to fundamentally change the role of oral corticosteroids in the management of asthma. Advances in therapy, 2023. 40(6): p. 2577-2594.
4. Kumar, K., T.S. Hinks, and A. Singanayagam, Treatment of COVID-19-exacerbated asthma: should systemic corticosteroids be used? American Journal of Physiology-Lung Cellular and Molecular Physiology, 2020. 318(6): p. L1244-L1247.
5. Martinez-Garcia, M.A., et al., Role of inhaled corticosteroids in reducing exacerbations in bronchiectasis patients with blood eosinophilia pooled post-hoc analysis of 2 randomized clinical trials. Respiratory Medicine, 2020. 172.
6. Maspero, J.F., et al., The use of systemic corticosteroids in asthma management in Latin American countries. World Allergy Organization Journal, 2023. 16(4): p. 100760.
7. Peerboom, S., et al., Predictors of a good response to inhaled corticosteroids in obesity-associated asthma. Biochemical pharmacology, 2020. 179: p. 113994.
8. Quint, J.K., A. Ariel, and P.J. Barnes, Rational use of inhaled corticosteroids for the treatment of COPD. npj Primary Care Respiratory Medicine, 2023. 33(1): p. 27.
9. Singh, D., et al., New versus old: the impact of changing patterns of inhaled corticosteroid prescribing and dosing regimens in asthma management. Advances in Therapy, 2022. 39(5): p. 1895-1914.
10. Watanabe, K., et al., Use of systemic corticosteroids for reasons other than asthma in subjects with asthma. Respiration, 2022. 101(2): p. 109-115.
11. Al Sulaiman, K., et al., The role of inhaled corticosteroids (ICS) in critically Ill patients with COVID-19: A multicenter, cohort study. Journal of Intensive Care Medicine, 2022. 37(2): p. 248-257.
12. Bafadhel, M., et al., Inhaled corticosteroids for the treatment of COVID-19. European Respiratory Review, 2022. 31(166).
13. Halpin, D.M., D. Singh, and R.M. Hadfield, Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective. European Respiratory Journal, 2020. 55(5).
14. Jackson, D.J. and L.B. Bacharier, Inhaled corticosteroids for the prevention of asthma exacerbations. Annals of Allergy, Asthma & Immunology, 2021. 127(5): p. 524-529.
15. Kearns, N., et al., Inhaled corticosteroids in acute asthma: a systemic review and meta-analysis. The Journal of Allergy and Clinical Immunology: In Practice, 2020. 8(2): p. 605-617. e6.
16. Maijers, I., et al., Oral steroid-sparing effect of high-dose inhaled corticosteroids in asthma. European Respiratory Journal, 2020. 55(1).
17. Marghli, S., et al., Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial. BMC Emergency Medicine, 2022. 22(1): p. 134.
18. Rodriguez-Martinez, C.E., M.P. Sossa-Briceño, and J.A. Castro-Rodriguez, Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma exacerbations: a cost-effectiveness analysis. Journal of Asthma, 2020. 57(9): p. 949-958.
19. Shang, W., et al., The safety of long-term use of inhaled corticosteroids in patients with asthma: a systematic review and meta-analysis. Clinical Immunology, 2022. 236: p. 108960.
20. Tan, D.J., et al., Does the use of inhaled corticosteroids in asthma benefit lung function in the long-term? A systematic review and meta-analysis. European Respiratory Review, 2021. 30(159).
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Muhammad Hamad Khan
Student of Kabir Medical College, Gandhara University, Peshawar, KPK, Pakistan.
Haroon Khan
MBBS, KABIR Medical College, Gandhara University, Peshawar, KPK, Pakistan.
Shafiq Ahmad
BDS, MPhil department of Pharmacology, Lecturer Pharmacology KMU, Institute of Dental Sciences, Kohat, KPK, Pakistan.
Muhammad Shahid
MBBS, MPhil. Pharmacology, Institute of Pharmaceutical Sciences, Khyber Medical University, Peshawar, KPK, Pakistan.
Aiza Ismail
Student of Kabir Medical College, Gandhara University, Peshawar, KPK, Pakistan.
Haseeb Haroon
BDS, MPhil. Scholar Pharmacology, Lecturer, Pharmacology Department, Kabir Medical College Gandhara University, Peshawar, KPK, Pakistan