title: Protection by budesonide and fluticasone on allergen-induced airway responses after discontinuation of therapy.
abstract: BACKGROUND
  Treatment with inhaled steroids is an effective method of reducing bronchoconstriction and airway inflammation after allergen challenge. However, the duration of the protective effects of inhaled steroids after discontinuation of therapy has not been established.
  
  
  OBJECTIVE
  We sought to evaluate the protective effect of 1 week of inhaled steroid therapy against inhaled allergen challenge 12 hours after discontinuation of therapy.
  
  
  METHODS
  In this randomized, double-blind, placebo-controlled crossover trial, 26 asthmatic subjects (>18 years old) not using inhaled steroids were administered 200 microg of budesonide twice daily, 200 microg of fluticasone twice daily, or placebo twice daily for 1 week. Twelve hours after discontinuation of therapy, subjects were administered an inhaled allergen challenge. Each treatment period was separated by a 3-week washout period.
  
  
  RESULTS
  When compared with placebo (26% +/- 14%), there was a slight but significant protection against the allergen-induced early response after fluticasone treatment (19% +/- 10%, P = .001) but not after budesonide treatment (23% +/- 13%, P = .08). However, when the area under the curve for the early airway response was examined, there was no difference between the 2 drugs in the amount of protection ( P = .62). Partial protection was demonstrated against the late-response allergen-induced sputum eosinophilia with both treatments ( P = .001). By contrast, no protection was observed against allergen-induced airway hyperresponsiveness for either treatment.
  
  
  CONCLUSIONS
  The protective effects of inhaled steroids against allergen-induced early responses, airway eosinophilia, and allergen-induced airway hyperresponsiveness are partially or completely lost as early as 12 hours after discontinuation of therapy.
authors.affiliation: Firestone Institute for Respiratory Health, St. Joseph's Hospital and McMaster University, Hamilton, Ontario, Canada. padmaja.subbarao@sickkids.ca
authors.forename: Padmaja
authors.initials: P
authors.lastname: Subbarao
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Dorman
authors.forename: Tracey
authors.initials: T
authors.lastname: Rerecich
authors.forename: Richard M
authors.initials: RM
authors.lastname: Watson
authors.forename: Gail M
authors.initials: GM
authors.lastname: Gauvreau
authors.forename: Paul M
authors.initials: PM
authors.lastname: O'Byrne
mesh_terms: D000328:Adult; D000485:Allergens / Q000276:immunology; D000730:Androstadienes / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000188:drug therapy; D001985:Bronchial Provocation Tests; D019819:Budesonide / Q000627:therapeutic use*; D004804:Eosinophils / Q000187:drug effects; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D000485:Allergens; D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D019819:Budesonide; D000068298:Fluticasone