Altered therapeutic response towards inhaled corticosteroids in asthmatics –smokers with mild asthma

The exposure to tobacco smoke could cause bronchoconstriction and acute asthma attack. Smoking asthmatics have an insufficient therapeutic response to the standard therapy and unsatisfactory improvement of the respiratory function. In a randomized parallel study, a therapeutic response to inhaled fluticasone propionate in a dose of 250 µg twice per day was determined in 38 asthmatics with mild asthma, smokers and nonsmokers. Short-acting ß2 agonist (salbutamol) in a dosage of 0.1 mg/per inhaled dose was used as a rescue medication when needed. In patients, asthma was detected with a positive metacholine test and/or positive bronchodilatator response of > 12% with ≥ 200 ml increase of FEV1. They were randomized in two groups according to sex, age and starting values of FEV1. Before and after 6 weeks of treatment with fluticasone propionate of the previously corticosteroid-naive patients, lung function test (spirometry) was performed. A statistically significant effect (p<0.05) was achieved during the fluticasone propionate therapy in a group of non-smoking asthmatic patients. The same effect was not seen in the group of smoking asthmatics. Although the percentage of elevated FEV1 values was small, it was satisfactory because of the starting FEV1 values in patients with mild asthma. More studies are needed in asthmatics determining the asthma symptom score, the number of night awakenings due to asthma, the asthma exacerbations and the frequency of rescue therapy usage which will define the altered therapeutic response to inhaled corticosteroids in smoking asthmatics.

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Analysis of induced sputum before and after withdrawal of treatment with inhaled corticosteroids in asthmatic patients

Clinical & Experimental Allergy ◽

10.1046/j.1365-2222.2000.00919.x ◽

2000 ◽

Vol 30 (12) ◽

pp. 1777-1784 ◽

Cited By ~ 23

Author(s):

D. Giannini ◽

A. Di Franco ◽

S. Cianchetti ◽

E. Bacci ◽

F. L. Dente ◽

...

Keyword(s):

Inhaled Corticosteroids ◽

Induced Sputum ◽

Asthmatic Patients ◽

Withdrawal Of Treatment ◽

Before And After

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Effect of β2 -adrenergic receptor gene Arg16Gly polymorphisms on response to long-acting β2-agonist in Chinese Han asthmatic patients

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2014.412 ◽

2014 ◽

Vol 9 ◽

Author(s):

Yuying Qiu ◽

Deping Zhang ◽

Yu Qin ◽

Kai-Sheng Yin

Keyword(s):

Fluticasone Propionate ◽

Asthma Control ◽

Adrenergic Receptor ◽

Inhaled Corticosteroids ◽

Receptor Gene ◽

Chinese Han ◽

Asthmatic Patients ◽

Significant Difference ◽

Β2 Adrenergic Receptor ◽

Adrenergic Receptor Gene

Background: To evaluate the effect of variation of the Arg16Gly polymorphism of the β2-adrenergic receptor gene on clinical response to salmeterol administered with fluticasone propionate in Chinese Han asthmatic patients. Methods: Moderate persistent asthmatic patients (n = 62) currently receiving short-acting β2-agonists were administered twice-daily therapy with salmeterol/fluticasone propionate 50/250 μg in a single inhaler for 12 weeks, followed by a 2-to-4-day run-out period. Using direct DNA sequencing, five single nucleotide polymorphisms (SNPs) in the promoter and coding block regions of β2-adrenergic receptor gene were determined in 62 subjects and haplotypes were combined. Results: There was sustained and significant improvement (p < 0.001) over baseline in all measures of asthma control in subjects receiving salmeterol and fluticasone, regardless of Arg16Gly genotype. However, there was no significant difference in the improvement among three genotypes (p > 0.05). Responses to salmeterol did not appear to be modified by haplotype pairs (p > 0.05). During the run-out period, all subjects had similar decreases in measures of asthma control, with no differences between genotypes (p > 0.05). Conclusions: Response to salmeterol does not vary with Arg16Gly polymorphisms after chronic dosing with inhaled corticosteroids in Chinese Han asthmatic patients.

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Effect of Vitamin A on Lung Function Test in patient with Chronic Bronchial Asthma

TAJ Journal of Teachers Association ◽

10.3329/taj.v27i1.37602 ◽

2018 ◽

Vol 27 (1) ◽

pp. 10-13

Author(s):

M Obaidulla Ibne Ali ◽

Nur E Atia ◽

Tohorul Islam ◽

MN Islam ◽

PM Basak ◽

...

Keyword(s):

Lung Function ◽

Vitamin A ◽

Bronchial Asthma ◽

Tissue Injury ◽

Inflammatory Cells ◽

Lung Function Test ◽

Asthmatic Patients ◽

Bronchial Lumen ◽

Before And After ◽

Anti Oxidant

In chronic bronchial asthma inflammation may be accompanied by intensive air flow limitation. Endogenous oxidants produced by overactive inflammatory cells destroy airway epithelium which slough into bronchial lumen and thus aggravates asthma. When oxidant overwhelm anti-oxidants, tissue injury and disease results. It is observed that decrease level of anti-oxidants in the lungs is a feature of chronic bronchial asthma and that there is a marked decrease of these levels during acute asthmatic attacks. These observations highlight the positive correlation between anti-oxidant therapy in asthmatic patients. The study was carried out to observe the changes in lung function in patients with chronic bronchial asthma both before and after supplementation of anti-oxidant vitamin A. Pulmonary function variables such as FVE, FEV1, FEV1/FVC%and PEFR were measured by spirometer in patients with chronic bronchial asthma both before and three month after supplementation of vitamin A 10,000 I.U orally daily. The mean FVC, FEV1, FEV1/FVC% and PEFR following vitamin A was unchanged significantly (P<0.001) than the pre supplementation values in patients with chronic bronchial asthma. This study reveals that no improvement of pulmonary functions occur after supplementation of anti-oxidant vitamin A in chronic bronchial asthma patients.TAJ 2014; 27(1): 10-13

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Patterns and Determinants of Compliance with Inhaled Steroids in Adults with Asthma

Canadian Respiratory Journal ◽

10.1155/2005/375454 ◽

2005 ◽

Vol 12 (4) ◽

pp. 211-217 ◽

Cited By ~ 27

Author(s):

Yves Lacasse ◽

Hélène Archibald ◽

Pierre Ernst ◽

Louis-Philippe Boulet

Keyword(s):

Fluticasone Propionate ◽

Inhaled Corticosteroids ◽

Electronic Devices ◽

Persistent Asthma ◽

Point Of View ◽

Review Of The Literature ◽

Asthmatic Patients ◽

Inhaled Steroids ◽

Maintenance Medication ◽

Daily Dose

BACKGROUND: Patient compliance with inhaled corticosteroids (ICS) in asthma is considered to be suboptimal.OBJECTIVES: To describe the patterns of compliance with ICS and identify factors determining the compliance to ICS in adults with asthma.METHODS: Based on a review of the literature and interviews with asthmatic patients who require the regular use of ICS, potential determinants of compliance to ICS were identified. Questionnaires related to these determinants were then administered to a cohort of patients from three subspecialty clinics, including two from university-affiliated centres. Patients with mild-to-moderate asthma who were 15 years of age and older and required (from the physician's point of view) ICS as maintenance medication because of persistent asthma were included in the study. Patients were followed for a period of 12 weeks. Compliance was measured using electronic devices.RESULTS: Data from 124 patients (51 men; mean age 47±15 years; mean prescribed daily dose of ICS [fluticasone propionate] 643±385 µg) were analyzed. On average, the patients took 72±24% of their prescription. Four patterns of compliance were observed and are described: 1A -- regular compliance (n=29); 1B -- irregular compliance (n=37); 2A -- regular noncompliance (n=24); and 2B -- irregular noncompliance (n=34). Among the potential predictors of noncompliance, age was the only significant predictor (compliance increased with increasing age). There was no difference in asthma control between compliant and noncompliant patients.CONCLUSION: Compliance to ICS in patients with asthma is often suboptimal and difficult to predict. The observations suggest that some asthmatics may be overtreated with ICS.

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Does Quality of Care Affect Rates of Hospitalization for Childhood Asthma?

PEDIATRICS ◽

10.1542/peds.98.1.18 ◽

1996 ◽

Vol 98 (1) ◽

pp. 18-23 ◽

Cited By ~ 14

Author(s):

Charles J. Homer ◽

Peter Szilagyi ◽

Lance Rodewald ◽

Sheila R. Bloom ◽

Peter Greenspan ◽

...

Keyword(s):

New York ◽

Childhood Asthma ◽

Inhaled Corticosteroids ◽

Rescue Therapy ◽

Retrospective Chart Review ◽

Preventive Therapy ◽

Asthmatic Patients ◽

Hospitalization Rates ◽

Oral Corticosteroids

Background. Hospitalization rates for childhood asthma are three times as high in Boston, Massachusetts, as in Rochester, New York; New Haven, Connecticut, rates are intermediate. We undertook this study to determine how care for children admitted for asthma varies across these communities. Methods. We performed a community-wide retrospective chart review. We reviewed a random sample of all asthma hospitalizations, from 1988 to 1990, of children 2 to 12 years old living in these communities (n = 614). Abstracted data included demographics, illness severity, and treatment before admission. Results. Compared with Rochester children, Boston children were less likely to have received maintenance preventive therapy (inhaled corticosteroids or cromolyn [odds ratio (OR), 0.4 (0.2, 0.9)]), acute "rescue" therapy (oral corticosteroids [OR, 0.2 (0.1, 0.4)]), or inhaled betaagonist therapy [OR, 0.5 (0.3, 1.0)]. A larger proportion of admitted asthmatic patients in Boston (34%) were in the least severely ill group—oxygen saturation 95% or above—compared with patients in Rochester (20%). Conclusions. The quality of ambulatory care, including choice of preventive therapies and thresholds for admission, likely plays a key role in determining community hospitalization rates for chronic conditions such as childhood asthma.

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Effects of Hydrofluoroalkane and Dry Powder-Formulated Corticosteroids on Sputum Inflammatory Markers in Asthmatic Patients

Canadian Respiratory Journal ◽

10.1155/2006/648392 ◽

2006 ◽

Vol 13 (2) ◽

pp. 73-78 ◽

Cited By ~ 11

Author(s):

Hans-Peter Hauber ◽

Rame Taha ◽

Celine Bergeron ◽

Vladimir Migounov ◽

Qutayba Hamid ◽

...

Keyword(s):

Inhaled Corticosteroids ◽

Dry Powder Inhaler ◽

Inflammatory Cells ◽

Placebo Treatment ◽

Cytokine Expression ◽

Induced Sputum ◽

Dry Powder ◽

Sputum Induction ◽

Asthmatic Patients ◽

Before And After

BACKGROUND: Inhaled corticosteroids are powerful drugs that can suppress airway inflammation in asthmatic patients. Deposition of most of the inhaled corticosteroid occurs mainly in the central airways. However, a new hydrofluoroalkane formulation of beclomethasone dipropionate (HFA-BDP) is preferentially deposited in the distal airways. Inflammatory characteristics of induced sputum have been shown to differ in samples collected early after sputum induction compared with later.OBJECTIVE: To compare the effects of HFA-BDP and budesonide in a dry powder inhaler (DPI-BUD) on inflammatory cells and inflammatory cytokine expression in early and late induced sputa compared with placebo.METHODS: Seventeen patients with mild, intermittent bronchial asthma were randomly assigned to two treatment groups: eight patients received HFA-BDP and nine patients received DPI-BUD. Each patient was treated with one of the active treatments and placebo (for four weeks), with a two-week washout interval in between. Inflammatory cells and expression of interleukin (IL)-4 and IL-5 were measured in early and late induced sputa before and after active treatment, as well as before and after placebo treatment using immunocytochemistry and in situ hybridization.RESULTS: Compared with placebo, eosinophils were significantly reduced in both early and late induced sputa after HFA-BDP treatment (P<0.05), whereas DPI-BUD had a significant effect only on early induced sputum. Both HFA-BDP and DPI-BUD decreased IL-4 expression in early and late induced sputa, but the effect was more prominent with HFA-BDP. IL-5 expression was reduced in both early and late induced sputa after HFA-BDP treatment. DPI-BUD significantly decreased IL-5 expression in early but not in late induced sputum. The number of lymphocytes was not altered by either treatment.CONCLUSIONS: HFA-BDP reduced eosinophilic inflammation and T helper 2-type cytokine expression in both early and late induced sputa, whereas the effect of DPI-BUD on inflammation was predominantly demonstrated in early induced sputum.

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