The use of inhaled corticosteroids (ICS) improved the lung function of prematurely born children in a randomised-controlled trial. The results suggest that bronchodilator responsiveness may be used to screen eligible infants for this approach.
Preterm-associated lung disease is a common complication and evidence indicates that the lung function of patients that were born preterm worsens over time [1,2]. A randomised, clinical trial demonstrated that ICS may be administered to improve lung function in preterm-born children . The current PICSI study, conducted by Prof. Shannon Simpson (Curtin University, Australia) and colleagues, randomised 170 survivors of very preterm birth (≤32 weeks gestation) to a 12-week course of the ICS fluticasone propionate or to placebo .
A modest but significant difference in % forced expiratory volume in 1 second (FEV1)-change was observed between the fluticasone arm (5.93%) and the placebo arm (1.75%; P=0.01). Changes in FEV1/forced vital capacity (FVC) also favoured the intervention arm over the placebo arm (3.69% vs -0.79%; P=0.013), as did changes in fractional exhaled nitric oxide (FeNO) (-4.92 vs 0.11; P=0.01). Prof. Simpson added that 21.3% of the participants had a clinically significant improvement in FEV1. Finally, multivariate analysis showed that bronchodilator responsiveness was an independent predictor of the efficacy of ICS in these participants (P<0.001).
“Although our study observed only a modest improvement in lung function after a course of ICS, a significant proportion of patients was highly responsive to this treatment,” according to Prof. Simpson. “Bronchodilator responsiveness may be used to screen for these patients, but further studies are needed to predict which children are most likely to benefit from ICS.”
- Kotecha SJ, et al. JAMA Pediatrics. 27 June, 2022. Doi: 10.1001/jamapediatrics.2022.1990.
- Simpson SJ, et al. Lancet Child Ado Health. 2018;2(5):350–359.
- Goulden N, et al. JAMA Pediatrics. 2022;176(2):133–141.
- Simpson S, et al. Inhaled corticosteroids to improve lung function in survivors of very preterm birth: PICSI RCT. ALERT 2, RCT2165, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
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Table of Contents: ERS 2022
Letter from the Editor
ERS 2022 Highlights Podcast
COVID-19: What Is New?
Does vilobelimab reduce mortality in severe COVID-19?
Awake proning not positive in COVID-19
Favipiravir may help patients over 60 years with COVID-19 to recover
Brensocatib fails in severe COVID-19
Inhaled agent under investigation for COVID-19
Accurate voice-based COVID-19 diagnostic test in development
Novel scoring tool for post-COVID syndrome aids clinicians and researchers
COPD: Therapies and Innovations
Icenticaftor achieves results on top of triple inhalation therapy in COPD
STARR2: A new approach for treating COPD exacerbations
COPD medication not effective in symptomatic smokers with preserved spirometry
Do digital tools improve physical activity in COPD?
Hyperpolarised gas MRI ready for clinical use
All About Asthma
Tezepelumab in asthma: mucus plugging down, lung function up
Digital asthma intervention improves health and reduces costs
Digitally enhanced therapy lowers treatment burden and costs in severe asthma
Mepolizumab beneficial for patients with severe eosinophilic asthma
Progress in Paediatrics
Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis
Inhaled corticosteroids useful in preterms with decreased lung function
Fish oil or vitamin D during pregnancy can prevent croup
Encouraging results of nintedanib in children with fibrosing ILD
Focus on Interventional Pulmonology
Head-to-head: lung volume reduction surgery vs endobronchial valves
Durable effect of endobronchial valves in severe emphysema
Cone beam CT-guided ENB improves detection of pulmonary nodules
Confirmatory mediastinoscopy not needed in resectable NSCLC
Sleep and Breathing Disorders
In the spotlight: Cancer trends in obstructive sleep apnoea
Impact of CPAP on cardiac endpoints in OSA
Sustained hypoxaemia predicts unprovoked VTE in OSA
CPAP therapy in the prevention of cardiovascular risk in patients with OSA
Other Remarkable Research
Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure
Antifibrotic therapy may slow down FVC decline in RAILD
Intravenous N-acetylcysteine performs well in hospitalised patients
Men and women respond differently to diesel exhaust
New trends in cystic lung diseases
ALK inhibition, guidelines, liquid biopsies, and immunotherapy
Ensartinib bests crizotinib in ALK-positive non-small cell lung cancer