(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Edema

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.

Topics: Adult; Beclomethasone; Chronic Disease; Constriction, Pathologic; Diagnosis, Differential; Edema; Epistaxis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Obstruction; Nose Deformities, Acquired; Nose Diseases; Paranasal Sinus Diseases; Prednisone; Sarcoidosis; Tissue Adhesions; Triamcinolone Acetonide

Active cigarette smoking has detrimental effects on asthma morbidity and severity. Angiopoietin-1 has been shown to protect the microvessels against plasma leakage, whereas angiopoietin-2 enhances vascular permeability and subsequently induces airway mucosal oedema. Therefore, it is recently thought that angiopoietin-2 may contribute to the pathophysiology of asthma.. To determine whether angiopoietin-2 levels in the airways are associated with clinical profiles in smoking asthmatics.. We measured angiopoietin-1 and -2 levels in induced sputum in 35 normal controls (18 non-smokers and 17 smokers) and 49 asthmatics (24 non-smokers and 25 smokers) before and after inhaled beclomethasone dipropionate (BDP: 800 microg/day) therapy for 12 weeks.. Angiopoietin-1 and -2 levels in induced sputum were significantly higher in asthmatics than in normal controls. Moreover, angiopoietin-2 levels were significantly higher in smoking asthmatics than in non-smoking asthmatics (P=0.0001). The airway vascular permeability index was also higher in smoking asthmatics than in non-smoking asthmatics. Moreover, the angiopoietin-2 level was positively correlated with the airway vascular permeability index (non-smoking asthmatics: r=0.87, P<0.001, smoking asthmatics: r=0.64, P=0.002). After BDP therapy, angiopoietin-1 levels were significantly decreased in non-smoking asthmatics, smoking-cessation asthmatics, and active-smoking asthmatics. In contrast, angiopoietin-2 levels did not differ from before to after BDP therapy in non-smoking asthmatics and active-smoking asthmatics. However, its levels were significantly decreased from before to after BDP therapy in smoking-cessation asthmatics (P=0.002). Although forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) before BDP therapy was comparable in all subgroups, this parameter after BDP therapy was significantly lower in active-smoking asthmatics than in non-smoking and smoking-cessation asthmatics. Moreover, the reduction in angiopoietin-2 levels after BDP therapy in smoking-cessation asthmatics was significantly correlated with an improvement in FEV(1)/FVC.. Angiopoietin-2 levels were elevated in the airways of smoking asthmatics, and its levels were associated with impaired airway responses.

Topics: Adult; Angiopoietin-1; Angiopoietin-2; Anti-Asthmatic Agents; Asthma; Beclomethasone; Capillary Permeability; Edema; Female; Forced Expiratory Volume; Humans; Male; Respiratory Mucosa; Smoking; Smoking Cessation; Sputum

Beclomethasone dipropionate (BDP) extrafine aerosol, a newly developed pressurized metered dose inhaler (pMDI) with a hydrofluoroalkane-134a (HFA) propellant (HFA-BDP; Qvar, 3M Pharmaceuticals, St. Paul, MN), has been shown to be effective in controlling asthma symptoms at approximately half the daily dose of chlorofluorocarbon (CFC)-BDP.. This study evaluated the long-term efficacy and safety of switching patients with asthma maintained on a stable dose of CFC-BDP pMDI to therapy with HFA-BDP pMDI at approximately half their previous daily dose of CFC-BDP.. This was an open-label, randomized, parallel-group multicenter trial. Patients with at least a 6-month history of asthma whose symptoms were controlled on CFC-BDP, 400 to 1600 microg daily, during a 2-week run-in period were randomized in a 1:3 ratio to CFC-BDP at the same daily dose or HFA-BDP at approximately half the daily dose of CFC-BDP for 12 months.. A total of 473 patients were randomized: 354 to HFA-BDP, 119 to CFC-BDP. There were no statistically significant differences between groups in mean change from baseline in morning (AM) peak expiratory flow rate or forced expiratory volume in one second throughout the study. There were no consistent differences between treatment groups in individual asthma symptoms or daily beta2-agonist use during the study. There was an increase in the percentage of symptom-free days between baseline and month 12 in the HFA-BDP group (11.5%) and the CFC-BDP group (4.6%). No statistically significant differences in serum osteocalcin levels or adverse events were seen during the study or in AM plasma cortisol levels at month 12.. Asthma control was maintained in patients switched from a stable dose of CFC-BDP (400 to 1600 microg daily) to HFA-BDP at approximately half the CFC-BDP dose (200 to 800 microg daily), and was maintained over the next 12 months. HFA-BDP demonstrated a similar safety profile to CFC-BDP; there were no differences between the agents with regard to systemic effects.

Topics: Administration, Inhalation; Adolescent; Adrenergic beta-Antagonists; Adult; Aerosol Propellants; Aerosols; Anti-Asthmatic Agents; Beclomethasone; Biomarkers; Chlorofluorocarbons; Depression; Drug Eruptions; Drug Therapy, Combination; Edema; Female; Forced Expiratory Volume; Gingivitis; Humans; Hydrocarbons, Fluorinated; Male; Middle Aged; Nebulizers and Vaporizers; Osteocalcin; Pain; Particle Size; Peak Expiratory Flow Rate; Respiratory Tract Diseases; Safety; Treatment Outcome; Vomiting

In a double blind study the effect of intranasal beclomethasone diproprionate aerosol (BDA) on the morphology of the mucosa of the middle nasal turbinate was examined. Histological specimens were taken from 22 patients receiving BDA and from 15 patients who had received a placebo. Specimens were taken before therapy and after one year of treatment. Polypectomy and ethmoidectomy had been performed on all patients prior to the beginning of treatment. The histological changes of allergic rhinitis were diminished to a greater extent in patients receiving BDA than in the patients in the placebo group. BDA therapy did not cause atrophic rhinitis nor other detrimental changes that could be demonstrated histologically.

Topics: Administration, Intranasal; Beclomethasone; Double-Blind Method; Edema; Eosinophils; Epithelium; Humans; Metaplasia; Nasal Mucosa; Rhinitis, Allergic, Perennial; Turbinates

Mometasone furoate (MF) is a topical glucocorticoid used for atopic dermatitis, allergic rhinitis, and bronchial asthma. To elucidate the usefulness of MF, the dissociation between local anti-inflammatory effects and systemic effects of MF was compared with that of beclomethasone 17,21-dipropionate (BDP). MF was more potent than BDP in croton oil-induced ear edema tests in mice. Oral systemic effects of MF were inversely lower than that of BDP on thymolysis, plasma corticosterone lowering, and suppression of body weight gain in mice. These results indicate that MF has a higher therapeutic index and superior clinical usefulness as a topical glucocorticoid compared to BDP.

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Inflammatory Agents; Beclomethasone; Corticosterone; Disease Models, Animal; Dose-Response Relationship, Drug; Edema; Male; Mice; Mice, Inbred ICR; Mometasone Furoate; Pituitary-Adrenal System; Pregnadienediols; Thymus Gland; Weight Gain

Excellent clinical results were obtained in 85 patients with chronic asthma who took corticosteroids (mostly triamcinolone) on a long-term basis for periods varying from one to 26 years. There was a minimum of side-effects, none serious; the most discomforting were ecchymosis and a tendency to easy bruising. The results of this and previous studies have convinced the author that corticosteroids, if judiciously used, are the most valuable adjunct we have in the treatment of acute and chronic asthma.

Topics: Acne Vulgaris; Adrenal Cortex Hormones; Asthma; Beclomethasone; Betamethasone; Body Weight; Dose-Response Relationship, Drug; Ecchymosis; Edema; Hirsutism; Humans; Prednisone; Triamcinolone

Topics: Administration, Oral; Administration, Topical; Animals; Anti-Inflammatory Agents; Beclomethasone; Carrageenan; Croton Oil; Dexamethasone; Ear; Edema; Fluocinolone Acetonide; Foot; Male; Propionates; Rats; Valerates