NEW YORK (Reuters Health) Jan 21 - Investigators in the Epidemiologic Study of Cystic Fibrosis show that the early use of inhaled corticosteroids slows the decline in lung function as measured by forced expiratory volume in one second (FEV1).
Dr. Clement L. Ren of the University of Rochester, New York, and co-investigators analyzed data from 2978 patients between 6 and 17 years of age enrolled in the Epidemiologic Study of Cystic Fibrosis between 1994 and 2004. They estimated the rate of decline in FEV1 before and after starting inhaled corticosteroid therapy.
Before inhaled corticosteroid therapy was initiated, mean FEV1 decline was -1.52% predicted per year. Afterward, mean FEV1 decline was -0.44% predicted per year, which the study group found to be a significant change (p = 0.002).
The net difference was 1.08% predicted per year, or a 70% reduction from the initial rate of FEV1 decline, the study group reports in the December issue of the Journal of Pediatrics.
"I would not use this study to recommend starting inhaled corticosteroids on any cystic fibrosis patient," Dr. Ren cautioned in an interview with Reuters Health. "We found an association between inhaled corticosteroids use and decreased FEV1 decline that was highly unlikely to have occurred by chance. But this finding really needs to be validated in a randomized controlled trial."
"Our study provides strong support for conducting such a study, because if in fact our observation is true, and inhaled corticosteroids really can impact FEV1 decline that significantly, then we really should be using it in CF patients."
"Right now, we don't know for sure that inhaled corticosteroids therapy is definitely beneficial for CF patients," Dr. Ren summed up. "In contrast, there are several other medications that have been shown to improve outcomes in CF: dornase alfa, inhaled tobramycin, low dose azithromycin, and hypertonic saline."
"Ultimately, the most important implication of our study is that it emphasizes the need to study further the role of inhaled corticosteroids in CF therapy. Many CF patients are already receiving inhaled corticosteroids, but we need better data on their efficacy and safety."
"I hope that our study will provide the impetus to conduct further research to resolve this important question," Dr. Ren said.
Source : http://www.medscape.com/viewarticle/587165
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