title: Efficacy of fluticasone metered-dose inhaler and dry powder inhaler for pediatric asthma.
abstract: BACKGROUND
  For the treatment of bronchial asthma, two types of fluticasone inhaler devices are available, namely, metered-dose inhaler with spacer (MDI-S) and the dry powder inhaler (DPI). The former is recommended for young children with a low peak inspiratory flow (PIF) and the latter for adolescents and adults. But the difference in the therapeutic efficacy between them has been studied only rarely in adolescent patients.
  
  
  METHODS
  In the present study, 21 post-elementary school-age patients with moderate persistent bronchial asthma (age 8-15 years, 10.3 +/- 2.1 years), who all had a sufficient PIF of 114 +/- 29 L/min, were examined in order to compare the two types of fluticasone inhalers. Eleven of 21 patients inhaled 200 microg/day Flutide using the MDI-S twice daily for 1 month in the first month, and the same dose using the DPI for the next month. The other 10 patients inhaled the opposite regimens. At the end of the each treatment, spirometry was examined.
  
  
  RESULTS
  Measurements done before therapy and then at the end of MDI-S and DPI therapy, respectively, were as follows: forced expiratory volume in 1 s (FEV(1.0)), 72.4 +/- 18.2%, 91.5 +/- 18.2% and 84.1 +/- 16.3% (MDI-S vs DPI, P > 0.040); maximal mid-expiratory flow (MMEF), 62.0 +/- 23.6%, 88.7 +/- 26.5%, 79.3 +/- 33.4% (P > 0.044) and the peak expiratory flow (PEF) was 73.9 +/- 25.0%, 95.6 +/- 32.8%, and 90.5 +/- 29.5%, respectively (n.s.). MDI-S was thus found to be more effective in terms of %FEV(1.0) and in %MMEF.
  
  
  CONCLUSIONS
  High therapeutic efficacy was obtained with the use of the MDI-S in fluticasone inhalation for post-elementary school-age patients with sufficient inspiration ability.
authors.affiliation: Department of Brain and Nerve Science, , Oita University Faculty of Medicine, Yufu, Oita, Japan. hmiya@med.oita-u.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyahara
authors.forename: Seigo
authors.initials: S
authors.lastname: Korematsu
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Nagakura
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000730:Androstadienes / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D016503:Drug Delivery Systems / Q000295:instrumentation; D000068298:Fluticasone; D006801:Humans; D036501:Metered Dose Inhalers; D011208:Powders
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D011208:Powders; D000068298:Fluticasone