Anti-inflammatory effects of high-dose inhaled fluticasone versush oral prednisone in moderate asthma exacerbations. A randomized clinical trial

¹ Clínica d'Asma i Al•lèrgia (Departament de Pneumologia) i Servei de Bioquímica, Hospital de la Santa Creu i de Sant Pau, Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona (España-Spain)

	Abstract

To study the kinetics of high doses of inhaled steroid fluticasone (F) in comparison with oral steroid prednisone (P) on plasma protein leakage and bronchial eosinophilia in adults with moderate asthma exacerbations.

A randomized, double-blind, placebo-controlled prospective trial.

Forty-five patients treated at the emergency department for moderate asthma exacerbations were recruited and 39 were assigned to receive either F and placebo of P (19 patients), or P and placebo of F (20 patients). Medication was delivered to all patients through a metered-dose inhaler and spacer (16 puffs; 4, 000 micrograms·day^-1 or placebo) plus one pill (prednisone 30mg·day^-1 or placebo). Spirometry and induced sputum (IS) for differential cell counts (DCC), albumin and alpha2-macroglobulin levels and blood eosinophils, IL-5 and GM-CSF levels were obtained before treatment (t0) and at 2, 6 and 24 hours.

Symptoms clearly improved after 24 hours in both groups. No differences were seen between groups in PEF or FEV₁ which improved progressively but decayed slightly after 24 hours. Eosinophil counts in sputum also improved over time in both groups. The effect was faster with F than with P (p=0.036 adjusting by baseline) but was partially lost at 24 hours. However, plasma proteins in sputum and eosinophil count in blood both decreased until 24 hours with no significant differences between groups. There was no correlation between eosinophil counts and plasmatic protein levels.

Both treatments improved symptoms, airway obstruction and inflammation, and plasma protein leakage at 24 hours. P reduced blood eosinophil counts while F reduced airway eosinophil counts, suggesting F's anti-inflammatory performance is exerted locally.