Effects Of Fluticasone Propionate Research Articles

Effects of fluticasone propionate and budesonide on the expression of immune defense genes in bronchial epithelial cells

BackgroundCOPD patients have increased risk of pneumonia when treated with fluticasone propionate (FP), whereas this is generally not the case with budesonide (BUD) treatment. We hypothesized that BUD and FP differentially affect the expression of immune defense genes. MethodsHuman bronchial epithelial 16HBE cells and air-liquid interface (ALI)-cultured primary bronchial epithelial cells (PBECs) were pre-treated with clinically equipotent concentrations of BUD or FP (0.16–16 nM BUD and 0.1–10 nM FP), and the expression of immune defense genes was studied at baseline and after exposure to rhinovirus (RV16). ResultsUsing microfluidic cards, we observed that both BUD and FP significantly suppressed CXCL8, IFNB1 and S100A8 mRNA expression in unstimulated 16HBE cells. Interestingly, BUD, but not FP, significantly increased lactotransferrin (LTF) expression. The difference between the effect of BUD and FP on LTF expression was statistically significant and confirmed by qPCR and at the protein level by western blotting. RV16 infection of ALI-cultured PBECs significantly increased the expression of CCL20, IFNB1 and S100A8, but not of LTF or CAMP/LL-37. In these RV16-exposed cells, LTF expression was again significantly higher upon pre-treatment with BUD than with FP. The same was observed for S100A8, but not for CCL20, IFNB1 or CAMP/LL-37 expression. ConclusionsTreatment of human bronchial epithelial cells with BUD results in significantly higher expression of specific immune defense genes than treatment with FP. The differential regulation of these immune defense genes may help to explain the clinical observation that BUD and FP treatment differ with respect to the risk of developing pneumonia in COPD.

Effect of fluticasone propionate on virus-induced airways inflammation and anti-viral immune responses in mice

BackgroundInhaled corticosteroids are commonly used in the treatment of asthma and chronic obstructive pulmonary disease, but their effects on viral loads and anti-viral responses are poorly characterised. The aim of this study was to assess effects of inhaled fluticasone propionate on rhinovirus infection in vivo, in a mouse model. We tested the hypothesis that this treatment would reduce virus-induced airways inflammation but that the effect would be confounded by interference with anti-viral immune responses, leading to delayed viral clearance. MethodsC57BL/6 mice were intranasally dosed with fluticasone propionate (1 mg/kg) or vehicle (dimethyl sulfoxide, control), 1 h before infection with rhinovirus 1B. We assessed bronchoalveolar lavage (BAL) inflammatory cell numbers, and measured gene expression, protein production of innate mediators, or both by quantitative RT-PCR or ELISA. We compared mice treated with fluticasone with controls at various timepoints after infection. In additional experiments, recombinant interferon (IFN) beta was administered with fluticasone and rhinovirus 1B in both groups of mice. FindingsAt 24 h post infection, fluticasone treatment suppressed rhinovirus induction of type I and III IFNs in the airways (for the fluticasone-treated group compared with controls: mean IFNβ BAL protein 20·2 pg/mL [SD 16·7] vs 103·0 [30·9]; mean IFNλ BAL protein 102·6 pg/mL [17·4] vs 217 [44·6], p<0·001); it also impaired viral clearance, with increased lung tissue viral RNA copy numbers (4·7 × 105 copies [SD 1·3] vs 2·6 × 105 [0·8], p<0·001). Despite increasing viral loads, fluticasone inhibited rhinovirus-induced airway inflammation as evidenced by suppressed BAL neutrophil numbers in fluticasone compared with control mice (0·021 × 105 [0·012] vs 0·59 × 5 [0·39], p<0·001) and by suppressed lymphocyte numbers (0·092 × 105 [0·044] vs 0·45 × 105 [0·11], p<0·001). By contrast, fluticasone increased MUC5AC proteins (158·2 arbitrary units [29·9] vs 107·6 [7·1], p=0·0165) and MUC5B proteins (623·8 arbitrary units [231·9] vs 413·5 [70·5], p=0·0476) in BAL at day 7 post infection. Administration of intranasal recombinant IFN beta (104 units) with fluticasone and rhinovirus 1B led to upregulation of interferon-inducible cytokines OAS and CXCL10/IP-10 compared with control mice treated with fluticasone and rhinovirus alone and improved viral clearance without having any effect on suppression of inflammation by fluticasone. InterpretationOur findings suggest that fluticasone treatment suppresses rhinovirus-induced airways inflammation in vivo but also impairs anti-viral immune responses and increases viral titres, leading to mucus hypersecretion. Since asthma and chronic obstructive pulmonary disease are both associated with inherent deficient IFN responses to rhinovirus, inhaled corticosteroids might interact synergistically with disease to inhibit IFN and thus lead to increased severity of exacerbation. The clinical applicability of these findings requires confirmation in human models of disease. FundingWellcome Trust.

Cytokine profiles, signalling pathways and effects of fluticasone propionate in respiratory syncytial virus‐infected human foetal lung fibroblasts

To examine cytokine production in response to RSV infection, we assessed the levels of 29 cytokines released from RSV-infected human foetal lung fibroblasts. We also examined the relationships between the effects of fluticasone propionate and various signalling pathways in the cells. Twenty-four hours after infection (1MOI), RSV-infected cells released cytokines, for example proinflammatory cytokines (IL-1β, IL-6 and TNF-α), anti-inflammatory (IL-1ra), Th1 (IFN-γ, IFN-λ1a, IL-2 and IL-12), Th2 (IL-4, IL-5, IL-10 and IL-13), granulopoiesis-inducing (G-CSF and GM-CSF), eosinophil recruitment-inducing (eotaxin and RANTES) and neutrophil recruitment-inducing cytokines (IL-8, IP-10, MCP-1 and MIP-1α). Aberrant release of most was significantly suppressed by fluticasone propionate. Twelve hours after RSV infection, increased phosphorylation of Akt, p38 MAPK, ERK1/2 and IκB-α was noted. Fluticasone propionate suppressed the phosphorylation of Akt, p38 MAPK, and ERK1/2, but not IκB-α, in virus-infected cells. TLR-4 expression was unchanged in control and RSV-infected cells, and TLR-3 and RIG-I expression was not detected. The results indicate that RSV infection induces aberrant production and release of certain cytokines through these signalling pathways in human lung fibroblasts. Overproduction and imbalance of these cytokines may be associated with the pathophysiology of RSV-induced excessive and allergic inflammation.

Comparative study of fluticasone propionate with budesonide and beclomethasone dipropionate in mild persistent bronchial asthma

Objective: To compare the efficacy and adverse effects of fluticasone propionate with that of budesonide and beclomethasone dipropionate in mild persistent cases of bronchial asthma. Methods: This was an open label, randomized parallel group study done in Government General and Chest Hospital, Hyderabad for a period of 12 weeks. Each group had 20 patients. The group I was given fluticasone propionate inhalation therapy 100μg twice daily. Group II was given budesonide inhalation therapy 200μg twice daily. Group III was given beclomethasone dipropionate inhalation therapy 200μg twice daily. Results: Symptomatic improvement was observed in all three groups. At end point, mean FEV1 in fluticasone propionate treatment group improved by 22.04% compared with 14.53% in budesonide and 12.02% in beclomethasone treatment groups. At end point, mean FVC value of the fluticasone propionate treatment group improved by 8.04% compared with 5.29% in budesonide and 4.27% in beclomethasone groups. Mean FEV1 / FVC also improved by 12.76% in the fluticasone propionate group compared with 8.63 % in budesonide and 7.45 % in beclomethasone groups. No adverse effects were reported in any of the treatment groups. Conclusion: This study showed that fluticasone propionate is superior to budesonide and beclomethasone in improving lung function, decreasing symptoms and need for rescue medication in mild persistent asthma

Effects of Low-Dose Fluticasone Propionate/Salmeterol Combination Therapy on Exhaled Nitric Oxide and Nitrite/Nitrate in Breath Condensates from Patients with Mild Persistent Asthma

Objective. The long-acting β2-agonist salmeterol in combination with the corticosteroid fluticasone propionate is used in clinical practice for the treatment of mild persistent asthma. Although the effect of fluticasone propionate alone in asthmatic patients is well documented, the effect of fluticasone propionate/salmeterol (FSC) combination therapy on airway inflammation and airway hyperresponsiveness (AHR) is not well characterized. Thus, we evaluated AHR, exhaled nitric oxide (FENO), and nitrite and nitrate in exhaled breath condensates (EBCs) from mild persistent asthmatic patients treated with a low-dose FSC (100/50). Methods. In this open label study, 18 mild persistent, steroid-naïve asthmatics (age, 22–62 years, forced expiratory volume in 1 s (FEV1) > 70% predicted, provocative dose resulting in 20% reduction (PD20) < 10 mg/mL) were treated with FSC 100/50 for 4 weeks. PD20 to methacholine, FEV1, FENO, and EBC nitrite and nitrate was measured before and after treatment. Results. After 4 weeks of therapy with FSC 100/50, FENO decreased from 74 ppb (SD = 37) to 34 ppb (SD = 15) (p < .001). FEV1 (% predicted) increased from 89.4 (SD = 10.7) to 93.3 (SD = 9.5) (p < .01). The PD20 for methacholine increased from 3.0 (±3.2) to 10.3 (±8.4) mg/mL (p < .01) in 3 of 18 patients reaching the maximum allowable dose (25 mg/mL). FENO correlated with the log of the methacholine dose. There was no statistically significant change in EBC nitrite and nitrate before and after treatment. Conclusions. Treatment of mild persistent, steroid-naïve asthmatics with low-dose combination therapy is effective in rapidly reducing airway inflammation and AHR. Our results suggest different metabolic origins for nitrite, nitrate, and FENO in this group of patients.

1716 Effects on Growth of Inhaled Corticosteroids in Asthmatic Children

BackgroundCorticosteroids may inhibit growth hormone (GH) axis, reducing GH release, decreasing tissue expression of growth factors, inhibiting IGF-1 bioactivity, osteoblast activity, promoting bone resorption.ObjectivesEvaluating adverse effects of inhaled corticosteroids used...

No effect of fluticasone propionate on linear growth in preschool children with asthma

Eighty percent of asthmatic children develop asthma symptoms by the age of 5 years. Inhaled corticosteroids (ICS), depending on dosage, may cause linear growth reduction and adrenal gland suppression. There are few studies about linear growth of preschool children with asthma. The aim of the present study was to investigate whether there is any effect of fluticasone propionate (FP) on linear growth and adrenal gland function. Twenty-eight children aged 18-52 months with persistent asthma receiving ICS FP 100-200 µg daily were studied for 1 year. Patients were divided into two groups according to clinical parameters: well (group 1) and poorly controlled (group 2). Height was measured every 3 months and expressed as height standard deviation score (SDS). Cumulative dose of FP expressed in mg was calculated for every patient. Early morning levels of serum adrenocorticotropic hormone (ACTH) and cortisol were assessed at the beginning and at the end of the study. Patients took FP for an average of 11 months in group 1 and 16 months in group 2, which was not statistically significantly different. At the end of the study height SDS difference was -0.0143 in group 1 and -0.2000 in group 2, which was not statistically significantly different (t= 0.6072, P= 0.5489). There was also no statistically significant difference for average cortisol (P= 0.4381) or ACTH (P= 0.5845) concentration at the end of the study. FP 100-200 µg daily had no effect on linear growth or on the hypothalamic-pituitary-adrenal gland axis but further follow up is necessary.

Effects of fluticasone propionate and salmeterol hydrofluoroalkane inhalation aerosol on asthma-related quality of life

Current asthma guidelines emphasize domains of impairment and risk for assessing severity and control, noting the need to consider separately the effects of asthma on asthma quality of life and functional capacity. Proper treatment to control asthma should result in improvements in patient well-being and functional status. To assess asthma-related quality of life after treatment with combination fluticasone propionate and salmeterol delivered via hydrofluoroalkane 134a metered-dose inhaler compared with the individual components alone. Asthma-related quality of life was assessed as part of two 12-week, randomized, double-blind, placebo-controlled clinical trials comparing the fluticasone propionate-salmeterol combination administered via a single metered-dose inhaler with salmeterol, fluticasone propionate, and placebo administered via traditional chlorofluorocarbon metered-dose inhaler. The Asthma Quality of Life Questionnaire was completed at baseline and end point. Score changes, overall and for the 4 separate domains, were compared within and among the treatment groups. A total of 720 of 725 patients completed a baseline Asthma Quality of Life Questionnaire and were included in the analyses. In both studies, all mean scores improved significantly from baseline with the fluticasone propionate-salmeterol combination, with significantly greater improvement in the overall score compared with salmeterol alone, fluticasone propionate alone, and placebo groups. Improvements with the combination were also clinically meaningful compared with changes with salmeterol and placebo in both studies and with fluticasone propionate in study 1. Treatment with combination fluticasone propionate and salmeterol delivered via hydrofluoroalkane metered-dose inhaler resulted in significantly greater improvements in asthma-related quality of life compared with individual components and placebo administered via traditional chlorofluorocarbon metered-dose inhaler.

Pharmacotherapy for Mortality Reduction in Chronic Obstructive Pulmonary Disease

Despite rapid advances in our understanding of its pathophysiology, chronic obstructive pulmonary disease (COPD) remains incurable. Although bronchodilators and theophyllines are commonly used to treat symptoms of dyspnea and cough and to acutely improve lung function, they do not modify the long-term decline in FEV(1). The principal goals of current COPD pharmacotherapy are to reduce exacerbations, improve health status, and prolong survival. There is strong evidence, including data from randomized clinical trials, that indicates inhaled corticosteroids alone, or in combination with a long-acting beta(2)-adrenoceptor agonist, improve patient symptoms, reduce morbidity, and perhaps even prolong survival in COPD. A recent individual patient-based meta-analysis of randomized, placebo-controlled trials of inhaled corticosteroids in COPD indicated that mortality over 3-4 yr was 27% lower in the group that received inhaled corticosteroids compared with the group that received placebo. Several short-term follow-up trials have also suggested a reduction in mortality with a combination of long-acting beta(2)-agonist and inhaled corticosteroids, and a large, long-term study that is currently ongoing (the Toward a Revolution in COPD Health [TORCH] study) will provide data on the effects of fluticasone propionate and salmeterol in combination on all-cause mortality. This article reviews some of the relevant epidemiologic and pathophysiologic processes that affect mortality in COPD and critically examines the effect of current COPD therapies on mortality.

Effect of fluticasone propionate and salmeterol in a single device, fluticasone propionate, and montelukast on overall asthma control, exacerbations, and costs

Inhaled corticosteroids are the most effective class of anti-inflammatory agents and are recommended for patients with persistent asthma. To compare the effectiveness of (1) fluticasone propionate, 100 microg, and salmeterol, 50 microg; (2) fluticasone propionate, 100 microg; and (3) montelukast, 10 mg, as first-line maintenance treatment for persistent asthma. Combined analysis of 4 clinical trials, 2 that compared fluticasone propionate-salmeterol with montelukast and 2 that compared fluticasone propionate with montelukast as initial asthma therapy. The 4 studies had a total of 1,910 patients 15 years or older with symptomatic asthma previously treated with inhaled short-acting beta2-agonists alone. At the end point, there were significantly greater increases in forced expiratory volume in 1 second with fluticasone propionate-salmeterol (0.57 L; P < or = .004) vs fluticasone propionate (0.48 L) and montelukast (0.31 L) and significantly greater increases in morning peak expiratory flow rate (84.9 L/min; P < .001) vs fluticasone propionate (56.0 L/min) and montelukast (36.1 L/min). Fluticasone propionate-salmeterol significantly increased the percentage of symptom- and rescue-free days and significantly reduced albuterol use vs fluticasone propionate and montelukast (P < or = .04 for both). Patients treated with fluticasone propionate and montelukast had 2.6 and 3.6 greater risk, respectively, of having an asthma-related exacerbation vs fluticasone propionate-salmeterol users. In addition, mean daily exacerbation costs per treated patient were dollars 0.41 for fluticasone propionate-salmeterol, dollars 4.60 for fluticasone propionate, and dollars 7.57 for montelukast, whereas mean daily costs per patient exacerbation for fluticasone propionate-salmeterol, fluticasone propionate, and montelukast were dollars 29, dollars 128, and dollars 154, respectively. Patients with symptomatic asthma previously treated with short-acting beta2-agonists only who require maintenance therapy are likely to have greater clinical benefits, lower risk of an asthma exacerbation, and reduced exacerbation-related costs when initiating therapy with fluticasone propionate-salmeterol vs fluticasone propionate or montelukast.

LACK OF EFFECT OF FLUTICASONE PROPIONATE AQUEOUS NASAL SPRAY ON THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN 2- AND 3-YEAR-OLD PATIENTS

Galant SP, Melamed IR, Nayak AS, et al. Pediatrics . 2003;112:96–100 To determine the effects of fluticasone propionate (FP) (200 μg daily) on the hypothalamic-pituitary-adrenal (HPA) axis among patients 2 to 3 years of age. Children 2 to 3 years of age who demonstrated positive skin test responses to ≥1 seasonal allergen and the presence of nasal symptoms …

Methodological issues in evaluating measures of health as outcomes for COPD

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with worse health and increased healthcare utilisation. The Inhaled Steroids in Obstructive Lung Disease in Europe (ISOLDE) study in COPD showed a 26% reduction in the yearly rate of exacerbations in patients treated with fluticasone propionate (FP) compared to placebo, but did not indicate which patients showed greatest benefit. In this study the patients were stratified into mild and moderate‐to‐severe COPD using the American Thoracic Society criterion of forced expiratory volume in one second (FEV₁) 50% predicted, and the total number of exacerbations and those requiring treatment with oral corticosteroids were examined. There were 391 (195 FP) patients with mild COPD and 359 (180 FP) patients with moderate‐to‐severe disease. The exacerbation rate was highly skewed in mild disease, but more normally distributed in moderate‐to‐severe disease. FP reduced the overall exacerbation rate in moderate‐to‐severe disease (FP median rate 1.47 yr⁻¹, placebo 1.75 yr⁻¹), but not in mild disease (FP 0.67 yr⁻¹, placebo 0.92 yr⁻¹). FP use was associated with fewer patients with ≥1 exacerbation·yr⁻¹ being treated with oral corticosteroids (mild: FP 8%, placebo 16%; moderate‐to‐severe: FP 17%, placebo 30%). Effects of fluticasone propionate on exacerbations were seen predominantly in patients with a postbronchodilator forced expiratory volume in one second &lt;50% predicted. These data support recommendations in the Global Initiative for Chronic Obstructive Disease treatment guidelines that inhaled corticosteroids should be considered in patients with moderate‐to‐severe chronic obstructive pulmonary disease who experience recurrent exacerbations.

Multiple analyses, multiple populations, one outcome: Lack of effect of fluticasone propionate on prepubescent growth

Multiple analyses, multiple populations, one outcome: Lack of effect of fluticasone propionate on prepubescent growth

Effects of fluticasone propionate on inflammatory cells in COPD: an ultrastructural examination of endobronchial biopsy tissue

Background: Inhaled corticosteroids (ICS) markedly reduce bronchial mucosal inflammation in asthma but whether they have an anti-inflammatory effect in airway tissue in chronic obstructive pulmonary disease (COPD) is unknown. Methods:...

Effects of fluticasone propionate in COPD patients with bronchial hyperresponsiveness

Background: Treatment of chronic obstructive pulmonary disease (COPD) with inhaled corticosteroids does not appear to be as effective as similar treatment of asthma. It seems that only certain subgroups of...

In vitro effects of fluticasone propionate on IL-13 production by mitogen-stimulated lymphocytes.

BACKGROUND: Corticosteroid administration produces multiple immunomodulatory effects, including down-regulation of cytokine production by CD4 T lymphocytes. Fluticasone propionate (FP) (Glaxo Smith&Kline, Greenford, UK), a highly lipophilic topical corticosteroid, has been shown to be safe and effective in the treatment of asthma and of both seasonal and perennial rhinitis. AIMS: To gain insight into the mechanisms of FP therapeutic effects, we evaluated interleukin (IL)-13 (a type 2 cytokine that seemingly plays a pivotal role in allergic mechanisms) production by mitogen-stimulated peripheral blood mononuclear cells (MNC) in vitro, treated or not with FP. METHODS: MNC from 10 healthy subjects and 10 asthmatic atopic patients with Parietaria allergy were stimulated v/v with phytohaemagglutinin (PHA) (50 gamma/ml) or with complete medium alone as a control. Culture supernatants, in vitro treated or not with 10(-7) or 10(-8) M FP, were collected after 48 or 72 h incubation. IL-13 production was assessed by enzyme-linked immunosorbent assay. In random selected samples, after 4 or 24 h of cell cultures, RNA was extracted and IL-4 and IL-5 reverse transcriptase-polymerase chain reaction (RT-PCR) products analyzed. RESULTS: At 48 h, there were no differences in IL-13 concentration in PHA-stimulated cultures between healthy subjects and asthmatic patients (93.6 +/- 18.9 versus 111.0 +/- 25.1 pg/ml). At 72 h, similar results were obtained (63.9 +/- 3.0 versus 73.3 +/- 2.5 pg/ml, respectively). At this time, however, IL-13 concentrations were significantly decreased versus 48 h both in asthmatics (p < 0.001) and in controls (p < 0.001). Treatment with 10(-7) M FP significantly reduced IL-13 production in healthy subjects and asthmatic patients both at 48 h (93.6 +/- 18.9 versus 50.50 +/- 10.6 pg/ml, p < 0.001, and 111.0 +/- 25.1 versus 59.3 +/- 13.6 pg/ml, p < 0.001, respectively) and at 72 h (63.9 +/- 9.6 versus 35.5 +/- 4.4 pg/ml, p < 0.001, and 73.3 +/- 8.0 versus 40.7 +/- 4.5 pg/ml, p < 0.001, respectively). Similar results were obtained with 10(-8) M FP at 48 and 72 h. Accordingly, evaluation of RT-PCR products from selected cell samples showed a FP dosage-dependent inhibition of IL-4 and IL-5 mRNA production both for healthy subjects and asthmatic patients. CONCLUSIONS: FP in vitro impairs IL-13 production by PHA-stimulated MNC from asthmatic and control subjects. This strengthens previous suggestions that IL-13 inhibition by steroids may, at least in part, account for their therapeutic effects.

612 Effect of fluticasone propionate aqueous nasal spray and ceterizine on nasal symptoms and underlying inflammation of allergic rhinitis

612 Effect of fluticasone propionate aqueous nasal spray and ceterizine on nasal symptoms and underlying inflammation of allergic rhinitis

The Effect of Fluticasone Propionate on Functional Status andSleep in Children With Asthma and on the Quality of Life of TheirParents

1. Mahajan P, 2. Pearlman D, 3. Okamoto L (1998) J Allergy Clin Immunol. 102:19–23. [OpenUrl][1][CrossRef][2][Medline][3][Web of Science][4] #### Purpose of the Study The purpose of the study was to assess the effect of treatment with fluticasone propionate (FP) on functional status and sleep disturbances in children and to evaluate possible changes in the quality of life of the parents of these children. ##### Study Population There was a placebo group of 106 children, average age 8.5 years; a group treated with 50 μg of FP bid numbering 111, average age 8.5 years; and a third group treated with 100 μg of FP, 108 patients, mean age of 8.2 years. ##### Study Methods Questionnaires were completed by parents and caregivers at baseline and at weeks 24 and 52, including the functional status II-R (FS II), the sleep scale for children (SLP-C), and the quality of life of parents … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2BAllergy%2Band%2BClinical%2BImmunology%26rft.stitle%253DJournal%2Bof%2BAllergy%2Band%2BClinical%2BImmunology%26rft.aulast%253DMahajan%26rft.auinit1%253DP.%26rft.volume%253D102%26rft.issue%253D1%26rft.spage%253D19%26rft.epage%253D23%26rft.atitle%253DThe%2Beffect%2Bof%2Bfluticasone%2Bpropionate%2Bon%2Bfunctional%2Bstatus%2Band%2Bsleep%2Bin%2Bchildren%2Bwith%2Basthma%2Band%2Bon%2Bthe%2Bquality%2Bof%2Blife%2Bof%2Btheir%2Bparents.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0091-6749%252898%252970050-8%26rft_id%253Dinfo%253Apmid%252F9679843%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0091-6749(98)70050-8&link_type=DOI [3]: /lookup/external-ref?access_num=9679843&link_type=MED&atom=%2Fpediatrics%2F104%2FSupplement_2%2F387.1.atom [4]: /lookup/external-ref?access_num=000074909500005&link_type=ISI

The effect of fluticasone propionate on functional status and sleep in children with asthma and on the quality of life of their parents

Background: Although in the past drug interventions were measured primarily on the basis of their efficacy and safety, today we are increasingly interested in what impact treatments have on the patient’s day-to-day activities and quality of life. Objectives: We sought to assess the effect of treatment with fluticasone propionate (FP) on functional status and sleep disturbances in children with asthma and to evaluate possible changes in the quality of life of the parents of these children after treatment. Methods: As part of a randomized, double-blind, parallel-group, placebo-controlled, multicenter study on the effects of FP powder (50 or 100 μg twice daily) on growth in children aged 4 to 11 years with mild-to-moderate asthma ( n = 325), parents/caregivers completed the following questionnaires at baseline and at weeks 24 and 52 of treatment: Functional Status IIR (FSII), Sleep Scale-Children (SLP-C), and Quality of Life of Parents of Asthmatic Children (QOL-PAC). Change from baseline to weeks 24 and 52 within each treatment group was analyzed by using paired t tests, and differences between treatment groups were analyzed by using analysis of covariance. Results: Mean FSII and SLP-C scores improved significantly over baseline values with either 50 or 100 μg FP at weeks 24 and 52 ( p < 0.05) and were significantly better than scores in theplacebo group ( p < 0.05). In contrast, FSII scores at week 52 and SLP-C scores at weeks 24 and 52 decreased significantly in the placebo group ( p < 0.05). QOL-PAC results revealed that scores on the Burden scale were significantly improved in both FP groups at weeks 24 and 52. Subjective Norms and Social scales improved significantly only in the 100 μg FP group at week 52. Conclusions: The results of this study show that FP (either 50 or 100 μg twice a day) was associated with significant improvements in functional status and decreased sleep disturbances in children with asthma. In addition, treatment of children with FP was associated with a decreased burden on the parents of these children with asthma. (J Allergy Clin Immunol 1998;102:19-23.)

The effect of fluticasone propionate on respiratory syncytial virus-induced chemokine release by a human bronchial epithelial cell line

Respiratory syncytial virus (RSV) is an important cause of bronchiolitis in infants, is an important trigger of asthma exacerbation, and stimulates chemokine production by human respiratory epithelial cells in vitro. We tested the effect of the corticosteroid fluticasone propionate (FP) on RSV-stimulated production of the chemokines interleukin 8 (IL-8) and RANTES (regulated upon activation, normal T cell expressed and secreted) by a human bronchial epithelial cell line, BEAS-2B. Confluent BEAS-2B cultures were inoculated with RSV at approximately 1 plaque-forming unit/cell, and media were collected at 24 h intervals. Concentrations of IL-8 and RANTES were measured in supernatants using ELISA. The effect of FP at varying concentrations on RSV-induced chemokine release was determined. RSV stimulated increased release of both IL-8 and RANTES, particularly at 24–48 h after virus inoculation. Significant but incomplete inhibition of RSV-stimulated increases for both chemokines was found when cultures were treated with FP at ≥10−8 M (for IL-8) or ≥10−7 M (for RANTES). There was no significant effect of FP on release of RSV itself from infected BEAS-2B cells. We conclude that a possible mechanism for the efficacy of inhaled corticosteroids in reducing the frequency or severity of asthma exacerbations is inhibition of virus-induced chemokine production by airway cells.