Prothrombotic state assessment in asthma and its relation to asthma severity and effect of inhaled corticosteroids

Abstract

Background Coagulation and fibrinolysis have been previously considered as processes that occurred only in blood vessels. Recently, there is increasing evidence that asthma has increased coagulation activation within airways that in turn may lead to an increase in venous thromboembolism. Aim To assess the prothrombotic state in asthmatic patients with different disease severity, correlate to inflammatory markers, in addition to the effect of inhaled corticosteroids (ICS). Patients and methods Ninety patients (30 in the healthy group, 30 in the mild asthma group, 30 in the moderate to severe asthma group) were enrolled in this case–control study. Hemostatic parameters [plasminogen activator inhibitor type 1 (PAI-1) and d-dimers] and inflammatory markers (neutrophil, eosinophils, C-reactive protein) in the peripheral blood were measured. The extent of the effect of different doses of ICS on both hemostatic and inflammatory parameters was assessed. Results Serum PAI-1 was significantly increased among moderate to severe asthmatics [6.0 (5.0–13.0) ng/ml] as compared with the mild asthmatic [3.6 (3.0–5.0) ng/ml] and the control group [4.5 (2.0–5.0) ng/ml]. Moderate to severe asthmatics had higher levels of d-dimer in comparison to mild asthmatic patients and the control group [310.0 (260–1280), 187.5 (160–220), 40.0 (30–70) µg/ml, respectively]. Both PAI-1 and d-dimer levels significantly correlated with ICS doses (r=0.309, P=0.016; r=0.303, P=0.019, respectively). Moreover, both PAI-1 and d-dimer levels increased significantly among asthmatics using medium to high doses of ICS. Conclusion Asthma as a chronic inflammatory disease may have a prothrombotic state, especially those with severe asthma and using high doses of ICS.

Keywords

• D-dimer
• inhaled corticosteroids
• plasminogen activator inhibitor type 1
• prothrombotic state
• severe asthma