title: The efficacy of single-high dose inhaled corticosteroid versus oral prednisone treatment on exhaled leukotriene and 8-isoprostane levels in mild to moderate asthmatic children with asthma exacerbation.
abstract: BACKGROUND
  The anti-inflammatory effect of high-dose inhaled corticosteroids (ICS) in children with asthma exacerbation is unknown. We aimed to investigate the efficacy of single-high dose ICS versus oral prednisone treatment followed by a course of six day high-dose ICS or oral prednisone (P) treatment on the concentrations of Cys-LTs and 8-isoprostane levels in the exhaled breath condensate (EBC) of children with asthma exacerbation.
  
  
  METHODS
  Ninety-four children with moderate-severe asthma exacerbation were evaluated with asthma scores, peak expiratory flow rate (PEF), forced expiratory volume in first second (FEV1) and exhaled Cys-LT and 8-isoprostane levels before and after treatment. EBC was collected from 52 patients before and four hours after treatment with inhaled fluticasone propionate (FP) (4000 μg) or P and after six days of treatment with FP-1000 μg/day or P. Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.
  
  
  RESULTS
  Both single high-dose FP (n=59) and p (n=35) treatment resulted in a significant improvement in asthma score (p<0.0001), PEF (p<0.0001), and FEV1 (p<0.0001). Cys-LT concentration in the EBC decreased significantly both after the initial treatment (p=0.001), and at the end of the six-day period in the FP group (p<0.0001). 8-Isoprostane concentration was lower only after six days of treatment with FP-1000 μg/day in the FP group (p=0.023). There was a significant decrease in exhaled Cys-LTs after four hours (p=0.012) and six days of P treatment (p=0.018) in children with asthma exacerbation.
  
  
  CONCLUSIONS
  High-dose ICS treatment may be useful in the treatment of children with asthma exacerbation. The effects start as early as after four hours. The suppression of Cys-LTs production contributes to the early effects. Suppression of both Cys-LTs and oxidants may favourably contribute to the effects observed later.
authors: Department of Pediatric Allergy and Immunology, Gaziantep University School of Medicine, Gaziantep, Turkey. Electronic address: okeskin@gantep.edu.tr.
authors: O
authors: O
authors: Keskin
authors: Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: U
authors: U
authors: Uluca
authors: Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: M
authors: M
authors: Keskin
authors: Department of Pulmonology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: B
authors: B
authors: Gogebakan
authors: Department of Pediatric Allergy and Immunology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: E
authors: E
authors: Kucukosmanoglu
authors: Department of Pediatric Allergy and Immunology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: M Y
authors: MY
authors: Ozkars
authors: Department of Biostatistics, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: S
authors: S
authors: Kul
authors: Department of Pulmonology, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: H
authors: H
authors: Bayram
authors: Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey.
authors: Y
authors: Y
authors: Coskun
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001944:Breath Tests; D002648:Child; D002985:Clinical Protocols; D015237:Dinoprost / Q000031:analogs & derivatives / Q000032:analysis; D018450:Disease Progression; D045853:Exhalation; D005260:Female; D006801:Humans; D015289:Leukotrienes / Q000032:analysis; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D011446:Prospective Studies; D014421:Turkey
chemical_list: D000305:Adrenal Cortex Hormones; D015289:Leukotrienes; C075750:8-epi-prostaglandin F2alpha; D015237:Dinoprost; D011241:Prednisone
keywords: 8-Isoprostane; Asthma exacerbation; Children; Cysteinyl leukotrienes; Exhaled breath condensate; Inhaled corticosteroids; Oral prednisone; Oxidative stress