Pediatrics & Neonatology
Volume 51, Issue 1 , Pages 31-36, February 2010

Effects of Budesonide and Fluticasone Propionate in Pediatric Asthma Patients

  • Lin-Yu Kuo

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Chih-Hsing Hung

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Hsing-I Tseng

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Jiunn-Ren Wu

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Yuh-Jyh Jong

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Yu-Te Chu

      Affiliations

    • Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Kaohsiung Medical University Hospital, 100 Tz-You 1st Road, Kaohsiung 807, Taiwan

Received 7 March 2009; received in revised form 9 June 2009; accepted 15 June 2009.

Article Outline

Background

Cytokines and chemokines play important roles in asthma. However, little information exists on the effects of inhaled corticosteroids on cytokine and chemokine plasma levels in childhood asthma. We compared the pharmaceutical effects of two inhaled corticosteroids used in pediatric patients with mild-to-moderate asthma, budesonide and fluticasone propionate.

Methods

Pediatric patients aged 5–18 years old were enrolled in this randomized, open-label, observer-blinded study and received 3 months of treatment with either inhaled budesonide (200 mg/puff) or fluticasone propionate (250 mg/puff), at two puffs per day. Peak expiratory flow (PEF), exhaled nitric oxide, Asthma Control Test (ACT), plasma levels of tumor necrosis factor-a, thymus and activation-regulated chemokine, and interferon-inducible protein 10 were measured before treatment and monthly for 3 months after treatment.

Results

There were six patients in the budesonide group, and eight in the fluticasone group. After 3 months, both groups showed improved PEF. In the first month, PEF improved more in the budesonide group than in the fluticasone group, though the difference was not significant. After treatment, ACT scores in both groups were well controlled, except for one patient in the fluticasone group. The fluticasone group had a more significant reduction in exhaled nitric oxide than the budesonide group in the first month.

Conclusion

Improvements in lung function were more rapid in the budesonide group than the fluticasone group. However, patients in the fluticasone group had better anti-inflammatory responses than those in the budesonide group. We conclude that each inhaled corticosteroids have its own clinical and laboratory effects.

Key Words:  asthma , budesonide , chemokine , cytokine , exhaled NO , fluticasone

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References 

  1. Barnes PJ , Chung KF , Page CP . Inflammatory mediators of asthma: an update . Pharmacol Rev . 1998;50:515–596
  2. Thomas PS . Tumour necrosis factor-alpha: the role of this multifunctional cytokine in asthma . Immunol Cell Biol . 2001;79:132–140
  3. Kips JC . Cytokines in asthma . Eur Respir J Suppl . 2001;34:24s–33s
  4. Bochner BS , Hudson SA , Xiao HQ , Liu MC . Release of both CCR4-active and CXCR3-active chemokines during human allergic pulmonary late-phase reactions . J Allergy Clin Immunol . 2003;112:930–934
  5. Liu L , Jarjour NN , Busse WW , Kelly EA . Enhanced generation of helper T type 1 and 2 chemokines in allergen-induced asthma . Am J Respir Crit Care Med . 2004;169:1118–1124
  6. Hung CH , Li CY , Lai YS , Hsu PC , Hua YM , Yang KD . Discrepant clinical responses and blood chemokine profiles between two non-steroidal anti-inflammatory medications for children with mild persistent asthma . Pediatr Allergy Immunol . 2005;16:306–309
  7. Leung TF , Wong CK , Lam CWK , et al.   Plasma TARC concentration may be a useful marker for asthmatic exacerbation in children . Eur Respir J . 2003;21:616–620
  8. Imai T , Baba M , Nishimura M , Kakizaki M , Takagi S , Yoshie O . The T cell-directed CC chemokine TARC is a highly specific biological ligand for CC chemokine receptor 4 . J Biol Chem . 1997;272:15036–15042
  9. Liu AH , Zeiger R , Sorkness C , et al.   Development and cross-sectional validation of the Childhood Asthma Control Test . J Allergy Clin Immunol . 2007;119:817–825
  10. Schatz M , Sorkness CA , Li JT , et al.   Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists . J Allergy Clin Immunol . 2006;117:549–556
  11. Global Initiative for Asthma. Global strategy for asthma management and prevention. In: National Institutes of Health. National Heart, Lung, and Blood Institute, 2008. Available at: http://www.ginasthma.com/ [Date accessed: December 20, 2008]
  12. Juniper EF , Kline PA , Vanzieleghem MA , Ramsdale EH , O'Byrne PM , Hargreave FE . Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics . Am Rev Respir Dis . 1990;142:832–836
  13. National Institutes of Health  . Expert panel report 3: guidelines for the diagnosis and management of asthma . Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf [Date accessed: December 20, 2008]
  14. Khor YH , Feltis BN , Reid DW , et al.   Airway cell and cytokine changes in early asthma deterioration after inhaled corticosteroid reduction . Clin Exp Allergy . 2007;37:1189–1198
  15. Nathan RA , Sorkness CA , Kosinski M , et al.   Development of the asthma control test: a survey for assessing asthma control . J Allergy Clin Immunol . 2004;113:59–65
  16. Burke C , Power CK , Norris A , Condez A , Schmekel B , Poulter LW . Lung function and immunopathological changes after inhaled corticosteroid therapy in asthma . Eur Respir J . 1992;5:73–79
  17. Burke CM , Sreenan S , Power CK , Pathmakanthan S , Poulter LW . Mechanism of action of inhaled corticosteroids in bronchial asthma: a controlled study . Eur Respir J . 1994;7:421S; [Abstract]
  18. Barnes PJ . Molecular mechanisms of glucocorticoid action in asthma . Pulm Pharmacol Ther . 1997;10:3–19
  19. Rizzo MC , Sole D . Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy . J Pediatr (Rio J) . 2006;82:S198–S205
  20. Panina-Bordignon P , Papi A , Mariani M , et al.   The C-C chemokine receptors CCR4 and CCR8 identify airway T cells of allergen-challenged atopic asthmatics . J Clin Invest . 2001;107:1357–1364
  21. Lai ST , Hung CH , Hua YM , Hsu SH , Jong YJ , Suen JL . T-helper 1-related chemokines in the exacerbation of childhood asthma . Pediatr Int . 2008;50:99–102
  22. Kips JC , Tavernier JH , Joos GF , Peleman RA , Pauwels RA . The potential role of tumour necrosis factor alpha in asthma . Clin Exp Allergy . 1993;23:247–250
  23. Kharitonov SA , Barnes PJ . Exhaled biomarkers . Chest . 2006;130:1541–1546
  24. Pijnenburg MW , De Jongste JC . Exhaled nitric oxide in childhood asthma: a review . Clin Exp Allergy . 2008;38:246–259
  25. Adams N , Lasserson TJ , Cates CJ , Jones PW . Fluticasone versus beclomethasone or budesonide for chronic asthma in adults and children . Cochrane Database Syst Rev . 2007; CD002310.
  26. Yang JZ , Young AL , Chiang PC , Thurston A , Pretzer DK . Fluticasone and budesonide nanosuspensions for pulmonary delivery: preparation, characterization, and pharmacokinetic studies . J Pharm Sci . 2008;97:4869–4878

PII: S1875-9572(10)60007-1

doi:10.1016/S1875-9572(10)60007-1

Pediatrics & Neonatology
Volume 51, Issue 1 , Pages 31-36, February 2010

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