Can Long-term Use of ICS Prevent Airway Remodeling?
Can Long-term Use of ICS Prevent Airway Remodeling?
Is there any evidence that long-term use of inhaled corticosteroids (ICS) in young children with asthma can prevent airway remodeling?
Stan Ting, MD
William W Storms, MD
Director, The William Storms Allergy Clinic, Colorado Springs, Colorado; Clinical Professor, University of Colorado Health Sciences Center, Denver, Colorado
This question is a follow-up to a previous question entitled, "If Inhaled Corticosteroids Are Initiated Early in Young Children, Will Long-term Outcomes Change?" The evidence to support the answer to this question, which asks whether ICS prevent airway remodeling, is controversial. First, there is no consistent agreement on what the definition of airway remodeling is, and whether it should be a measure of lung function with irreversibility or a histopathologic change in airway biopsies. There are numerous changes that have been seen in airway biopsies, and some of these have been improved with ICS, but these improvements are not consistent. For this reason, the current consensus among experts is that ICS should be used early in the treatment of asthma to control the inflammation with the hope that they will prevent airway remodeling. However, we cannot say with assuredness that ICS will prevent airway remodeling; the evidence for the latter is not available.
Question
Is there any evidence that long-term use of inhaled corticosteroids (ICS) in young children with asthma can prevent airway remodeling?
Stan Ting, MD
Response From the Expert
William W Storms, MD
Director, The William Storms Allergy Clinic, Colorado Springs, Colorado; Clinical Professor, University of Colorado Health Sciences Center, Denver, Colorado
This question is a follow-up to a previous question entitled, "If Inhaled Corticosteroids Are Initiated Early in Young Children, Will Long-term Outcomes Change?" The evidence to support the answer to this question, which asks whether ICS prevent airway remodeling, is controversial. First, there is no consistent agreement on what the definition of airway remodeling is, and whether it should be a measure of lung function with irreversibility or a histopathologic change in airway biopsies. There are numerous changes that have been seen in airway biopsies, and some of these have been improved with ICS, but these improvements are not consistent. For this reason, the current consensus among experts is that ICS should be used early in the treatment of asthma to control the inflammation with the hope that they will prevent airway remodeling. However, we cannot say with assuredness that ICS will prevent airway remodeling; the evidence for the latter is not available.
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