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Fluticasone propionate and bronchial hyperresponsiveness in childhood asthma
C Direkwattanachai1, K Limkittikul, C Kraisarin
1Department of Pediatrics and Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
High-dose fluticasone propionate (FP) significantly improved airway hyperresponsiveness in children with asthma after four weeks of treatment. This inhaled corticosteroid demonstrates efficacy in managing this chronic respiratory condition.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Allergy and Immunology
Background:
- Bronchial asthma is a chronic airway inflammatory disease.
- Inhaled corticosteroids are standard preventive therapy for asthma.
- Concerns regarding optimal use, safety, and efficacy of inhaled steroids persist, especially in children.
Purpose of the Study:
- To evaluate the efficacy of high-dose fluticasone propionate (FP) in asthmatic children.
- To assess the impact of FP on airway hyperresponsiveness in pediatric asthma patients.
Main Methods:
- A study involving thirteen children (aged 7-17 years) with asthma.
- Treatment with high-dose inhaled fluticasone propionate (500 microg/day) for four weeks.
- Methacholine bronchial challenge test to measure the provocative dose of 20% decrease in FEV1 (PD20) pre- and post-treatment.
Main Results:
- Fluticasone propionate (FP) significantly increased the PD20, indicating reduced airway hyperresponsiveness (4.9-fold increase, p=0.004).
- The mean PD20 increased from 21.6 to 106.6 inhalation units after four weeks of FP treatment.
- All pediatric participants showed clinical improvement in their asthma symptoms.
Conclusions:
- High-dose fluticasone propionate (500 microg/day) is effective in reducing bronchial hyperresponsiveness in children with asthma.
- The anti-inflammatory effects of FP markedly improve airway reactivity, a key abnormality in asthma.
- Inhaled FP demonstrates a favorable risk/benefit profile for managing pediatric asthma.
Abstract:
Bronchial asthma is now agreed as being a chronic inflammatory disease of the airways. Inhaled steroids are widely accepted as a preventive medication in asthmatic patients of all ages and severity. However, the optimal use of inhaled steroids and the important issue of safety and efficacy still remain of concern, particularly in children. Recently, fluticasone propionate (FP) has been developed for use as an inhaled preparation for the treatment of asthma. Because of its high topical potency and increased lipophilicity, it is claimed that FP has an improved risk/benefit compared with other inhaled steroids. In order to evaluate the use of FP in children, we have studied the efficacy of high dose FP (500 microg/day) in asthmatic children. Thirteen children (9 boys and 4 girls), aged 7-17 years (10.8 +/- 2.6), were instructed to use a pressurized metered-dose inhaler connected to a Volumetric spacer. The standard methacholine bronchial challenge test was used as a principal outcome parameter. The PD20, a cumulative dose of methacholine inducing a 20% decrease in FEV1, was measured pre- and post-treatment with inhaled FP. After 4 weeks of FP, PD20 significantly increased from 21.6 +/- 14.3 inhalation unit to 106.6 +/- 78.5 inhalation unit (4.9 fold, p = 0.004) reflecting the improvement of airway reactivity. All subjects improved clinically. These results demonstrate that the anti-inflammatory action of FP 500 microg a day for four weeks can markedly reduce bronchial hyperresponsiveness, the basic physiologic abnormality in bronchial asthma.