fluticasone and Crohn-Disease

Topics: Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Clinical Trials as Topic; Colitis, Ulcerative; Crohn Disease; Fluticasone; Humans; Hydrocortisone; Prednisolone; Pregnenediones

We report a case of tracheo-bronchitis in Crohn's disease. A 23-year-old Japanese woman who had been diagnosed with Crohn's disease three years previously was hospitalized. She had been suffering from dry cough for one month. Computed tomography of the chest revealed marked thickening of the tracheal wall. Bronchoscopy showed erythematous and edematous mucosa with diffuse whitish granular lesions in the trachea and bronchi. The bronchial biopsy specimens showed non-specific inflammatory infiltrates consisting of lymphocytes and plasma cells, and hyperplasia of bronchial glands. Inhaled corticotherapy, fluticasone propionate 800 microg/day, was effective for both the inflammatory mucosa and thickened tracheal wall.

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Inflammatory Agents; Bronchitis; Bronchoscopy; Crohn Disease; Female; Fluticasone; Humans; Tomography, X-Ray Computed; Tracheitis

Fluticasone propionate, a topically active corticosteroid of low systemic bioavailability after oral administration, has been used in a pilot study for the treatment of mild and moderately active Crohn's disease. Twelve patients received oral fluticasone propionate for three weeks, and the effects were monitored using the Crohn's disease activity index and by 111In granulocyte scanning, assessing inflammation from scan appearances, four day faecal excretion of radioactivity, and whole body excretion of radioactivity. All patients completed the trial. No serious side effects were reported. There was a significant fall in Crohn's disease activity index values over the three week treatment period (193 (84) v 122 (51), p less than 0.01). 111In leucocyte scan images were improved (seven patients) or unchanged (five patients). There was a significant fall in excretion of injected radioactivity calculated from whole body data (28 (21)% v 14 (0.7)%, p less than 0.05). There were no changes in plasma cortisol values, either basal or synacthen stimulated. Fluticasone propionate is a promising therapeutic agent for Crohn's disease that offers the possibility of controlling inflammation without inducing systemic corticosteroid side effects and which merits evaluation in a double blind trial versus conventional corticosteroids.

Topics: Administration, Topical; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Crohn Disease; Drug Evaluation; Feces; Female; Fluticasone; Glucocorticoids; Granulocytes; Humans; Indium Radioisotopes; Male; Middle Aged; Pilot Projects; Time Factors