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

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• 作者：O. Keskin^a ; ^{okeskin@gantep.edu.tr" class="auth_mail" title="E-mail the corresponding author} ; ^{okeskin02@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; U. Uluca^b ; M. Keskin^b ; B. Gogebakan^c ; E. Kucukosmanoglu^a ; M.Y. Ozkars^a ; S. Kul^d ; H. Bayram^c ; Y. Coskun^b
• 关键词：ICS ; inhaled corticosteroid ; Cys-LTs ; cysteinyl leukotrienes ; EBC ; exhaled breath condensate ; PEF ; peak expiratory flow rate ; FEV1 ; forced expiratory volume in first second ; ELISA ; enzyme linked immunoassay ; FP ; fluticasone propionate ; P ; oral prednisone ; BAL ; bronchoalveolar lavage
• 刊名：Allergologia et Immunopathologia
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：44
• 期：2
• 页码：138-148
• 全文大小：1028 K

文摘

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.