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Published online before print February 20, 2008
Eur Respir J 2008, doi:10.1183/09031936.00082407
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ORIGINAL ARTICLE

Ciclesonide improves measures of small airway involvement in asthma

J. Cohen 1, W. Rob Douma 1, N.H.T. ten Hacken 1, J.M. Vonk 2, M. Oudkerk 3, D.S. Postma 1*

1 Dept of Pulmonology
2 Epidemiology
3 Radiology, University Medical Center Groningen, University of Groningen, The Netherlands

* To whom correspondence should be addressed. E-mail: d.s.postma{at}int.umcg.nl.


  Abstract

Ciclesonide is delivered as a small-particle inhaled corticosteroid and improves lung function and airway hyperresponsiveness.

To assess whether ciclesonide can specifically improve small airway function in asthma.

Sixteen mild-to-moderate asthma patients (7 males, median age 39 (range 19–56) years, FEV1%predicted 89% (range 62–120)) were randomized to 5-week treatment with placebo or 320 µg ciclesonide once daily. The following small airway parameters were assessed: FEF25–75%, percentage fall in FVC at PC20adenosine-'5-monophosphate (AMP) and at PC20methacholine (MCh), expiratory lung volume after MCh challenge on Computed Tomography (CT) scan, Single Breath N2 closing volume, and alveolar exhaled Nitric Oxide (eNO).

Seven subjects received placebo, nine ciclesonide. Both CT measurements of expiratory lung volume after MCh challenge and alveolar eNO decreased significantly more with ciclesonide, median (range) 4.4 ppb (1.4–54.8) and 59 mL (1569 to -117) respectively, than with placebo, -0.4 ppb (7.3 to -3.4) and -121 mL (20 to -236) respectively (p<0.05). Ciclesonide did not significantly improve other small airways parameters.

Inflammation and patency of small airways, reflected by alveolar eNO and air trapping on CT scan, both improve with ciclesonide even in this small number of patients. This indicates that ciclesonide exerts anti-inflammatory effects on small airways.

Keywords:  Asthma, ciclesonide, small airways




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