One-year evaluation of the preventative effect of hydrofluoroalkane-beclomethasone dipropionate on eosinophilic inflammation of asthmatic peripheral airways.
BACKGROUND
In asthmatic patients with eosinophilic inflammation of the peripheral airways, appropriate drug delivery to the affected area is required.


OBJECTIVE
It was the aim of this study to assess persistent eosinophilic inflammation of the peripheral airways in asthmatic patients, stabilized by the long-term use of dry powder type inhaled steroids, and to evaluate the clinical efficacy of hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) over 1 year.


METHODS
Seventy-four outpatients with moderate stable asthma were studied for at least 6 months, 37 treated with fluticasone propionate Diskus (FP-DK) and 37 with budesonide Turbuhaler (BUD-TH). The eosinophil count, eosinophil cationic protein (ECP), eotaxin and RANTES levels in 10% hypertonic saline-induced sputum were examined before treatment, as well as 4 weeks, 8 weeks, 6 months and 1 year after switching patients to HFA-BDP.


RESULTS
Fifteen patients (40.5%) in the FP-DK group and 12 (32.4%) in the BUD-TH group had eosinophils in induced sputum. The sputum ECP in the eosinophil-positive and the eosinophil-negative groups was 1,510.1 +/- 2,009.3 versus 426.6 +/- 464.1 microg/l (p = 0.037) in the FP-DK group, and 3,850.0 +/- 5,486.2 versus 492.0 +/- 1,150.7 microg/l (p = 0.011) in the BUD-TH group, respectively. Four weeks after the switch to HFA-BDP, the number of eosinophil-positive patients decreased in both groups. Significant reductions in sputum ECP and eotaxin were observed at 8 weeks, and their concentrations continued decreasing for 1 year.


CONCLUSIONS
There is a certain proportion of asthmatic patients for whom long-term treatment with dry powder type steroids may not be suitable; however, their peripheral airway inflammation improved after switching them to HFA-BDP, suggesting its excellent delivery.
Ohbayashi
Hiroyuki
H
Department of Allergy and Respiratory Medicine, Tohno-Kousei Hospital, Mizunami, Gifu Pref. 509-6101, Japan. ohbayasi@nn.iij4u.or.jp
D000280:Administration, Inhalation; D000335:Aerosol Propellants / Q000008:administration & dosage*; D000368:Aged; D001249:Asthma / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001507:Beclomethasone / Q000008:administration & dosage*; D001991:Bronchitis / Q000150:complications / Q000473:pathology / Q000517:prevention & control*; D004802:Eosinophilia / Q000473:pathology / Q000517:prevention & control*; D004804:Eosinophils / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D006845:Hydrocarbons, Fluorinated / Q000008:administration & dosage*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D013183:Sputum / Q000166:cytology; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology; D005466:Fluorocarbons
D000335:Aerosol Propellants; D001507:Beclomethasone; D005938:Glucocorticoids; D006845:Hydrocarbons, Fluorinated; C094049:apaflurane; D005466:Fluorocarbons