Reduction in Bronchial Responsiveness

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It is well recognized that long-term treatment with ICS leads to a reduction in bronchial hyper-responsiveness (BHR) to different stimuli, including histamine, methacholine, allergen, and exercise (12,13). This occurs within a few weeks of starting treatment, with continued improvement over a period of months (14). For asthmatic individuals, this response means that a lesser degree of bronchoconstriction occurs when exposed to provoking stimuli in their daily lives. On a population level, it indicates that the widespread use of ICS will result in a significant reduction in the proportion of severe asthmatics within a community (15) (Fig. 2).

However, the inability of ICS to reverse the degree of hyper-responsiveness to normal, and the return to previous baseline levels after

Figure 2 A reduction in bronchial hyper-responsiveness through the use of inhaled corticosteroid therapy will lead to a marked reduction in the proportion of severe asthmatics within an asthmatic population. Source: From Ref. 15.

stopping therapy (16,17), indicates that they do not appear to affect the long-term natural history of the disease, i.e., they do not lead to a "cure." Furthermore, these observations indicate that the predominant structural changes associated with remodeling cannot be reversed by ICS therapy. However, there are some data suggesting that ICS limit the maximum degree of airway narrowing in response to provoking stimuli in subjects with mild asthma (18).

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