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Asthma
Original research
Early clinical remission and its role in lung function decline and exacerbation in adult Korean patients with asthma
  1. Eunhye Bae1,
  2. Hyun-Jun Park2,
  3. Heemoon Park3,
  4. Jung-Kyu Lee3,
  5. Eun Young Heo3,
  6. Chang Hoon Lee2,
  7. Deog Kyeom Kim3,
  8. Hyun Woo Lee3
  1. 1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Korea (the Republic of)
  2. 2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  3. 3 Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Hyun Woo Lee; athrunzara86{at}gmail.com

Abstract

Introduction Despite advancements in asthma management, many patients continue to experience poor disease control, lung function decline, and frequent exacerbations. Clinical remission (CR) has been proposed as a novel treatment target and surrogate marker for long-term outcomes. This study evaluates whether early CR at 1 year after inhaled corticosteroid (ICS) initiation influences lung function decline and exacerbation risk in asthma.

Methods This retrospective cohort study evaluated 492 asthma patients treated with ICS at two teaching hospitals. Patients were classified into early CR and non-early CR groups. Early CR was defined based on a composite set of criteria, including sustained absence of exacerbations, no systemic corticosteroid use, symptom control and stable or improved lung function in the first year following ICS initiation. Study outcomes were the annual forced expiratory volume in one second (FEV1) decline and the moderate-to-severe exacerbations.

Results Early CR was significantly associated with slower annual FEV1 decline (4-component CR, adjusted β=31.6 mL/year, p=0.001; 3-component CR, adjusted β=15.7 mL/year, p=0.043). The benefits of early 4-component CR on attenuating annual FEV1 decline were more pronounced in specific phenotypes, including type-2 high asthma, persistent airflow limitation, severe asthma and patients requiring add-on long-acting muscarinic antagonists. Early 4-component CR had a reduced risk of moderate-to-severe (adjusted HR (aHR)=0.591, p=0.011) and severe exacerbations (aHR=0.508, p=0.025).

Conclusions Achieving CR within 1 year of ICS initiation was associated with improved lung function preservation and reduced exacerbation risk. These findings suggest the importance of achieving early CR as a clinical target in asthma management.

  • Asthma
  • Glucocorticoids
  • Remission Induction
  • Respiratory Function Tests
  • Forced Expiratory Volume
  • Symptom Flare Up

Data availability statement

Data are available on reasonable request. The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from IRB Committee of SNU-SMG Boramae Medical Center on reasonable request.

https://doi.org/10.1136/thorax-2024-222679

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    Data availability statement

    Data are available on reasonable request. The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from IRB Committee of SNU-SMG Boramae Medical Center on reasonable request.

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    Footnotes

    • EB and H-JP contributed equally.

    • Contributors Study concept and design: HWL. Acquisition of data: H-JP, HP, J-KL, EYH, CHL, DKK and HWL. Analysis and interpretation of data: EB, J-KL, CHL, DKK and HWL. Drafting the manuscript: EB and HWL. Critical revision of the manuscript and important intellectual content: J-KL, CHL, DKK and HWL. Study supervision: HWL. Guarantor: HWL.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.