fluticasone and Respiration-Disorders

Chronic carbon black exposure in the work environment can cause both respiratory symptoms and changes in lung function. There is limited information on the respiratory effects of acute exposure to carbon black.. Case report and literature review.. A 44-year-old man had intense exposure to carbon black when his crane ran into a truck with a trailer filled with carbon black. One week after this exposure he developed shortness of breath and cough with sputum production. These symptoms persisted and increased in intensity. Physical examination revealed expiratory wheezes when in the supine position. Pulmonary function tests revealed a mild obstructive ventilatory defect with a reduced FEV(1)/FVC ratio. The patient responded to treatment with fluticasone and salmeterol with a reduction in symptoms and improvement in his spirometry to a normal range.. Acute exposure to carbon black can cause respiratory symptoms and an obstructive ventilatory defect. This presentation suggests a small airway disease which improved over time with inhaled steroids and long-acting beta-agonists. Patients with intense carbon black exposure following industrial accidents will need frequent evaluation to manage any related respiratory tract injury.

Topics: Accidents, Occupational; Adult; Albuterol; Androstadienes; Bronchodilator Agents; Fluticasone; Forced Expiratory Volume; Humans; Male; Motor Vehicles; Occupational Diseases; Occupational Exposure; Respiration Disorders; Respiratory Function Tests; Salmeterol Xinafoate; Soot; Treatment Outcome; United States

Therapy with inhaled corticosteroids (ICS) is beneficial in patients with asthma. However, in preschool children with symptoms like cough, wheeze, or shortness of breath diagnosing asthma is difficult. Therefore, the role of ICS in the management of preschool children with recurrent respiratory symptoms is unclear. We assessed the effectiveness of ICS in preschool children with recurrent respiratory symptoms in general practice.. In this multicenter, randomized, double blind, placebo controlled trial, 96 children aged 1-5 years consulting their general practitioners for recurrent respiratory symptoms and in whom treatment with ICS was considered by the general practitioner were randomly allocated to receive ICS (fluticasone propionate 200 mcg/day by metered dose inhaler/spacer combination) or placebo for 6 months. Outcome assessments were carried out 1, 3, and 6 months after randomization. The primary outcome measure was the symptom score (cough, shortness of breath and wheeze during day and night) as measured by a symptom diary card. Secondary endpoints were symptom-free days, use of rescue medication, adverse events, and lung function variables as measured by the interrupter technique and forced oscillation technique.. During the 6 months treatment period, symptoms improved in both groups, with no differences between ICS and placebo. In addition, none of the secondary outcome parameters showed differences between both treatment groups.. ICS treatment has no beneficial effect in preschool children with recurrent respiratory symptoms in general practice. We therefore recommend a watchful waiting policy with only symptomatic treatment in these children. General practitioners and pediatricians should be aware of the high probability of overtreatment when prescribing ICS in these children.

Topics: Administration, Inhalation; Androstadienes; Anti-Inflammatory Agents; Child, Preschool; Double-Blind Method; Family Practice; Female; Fluticasone; Glucocorticoids; Humans; Infant; Male; Metered Dose Inhalers; Respiration Disorders

In a double blind randomised controlled trial, 30 infants with chronic lung disease received fluticasone propionate or placebo for one year. There were no significant differences between treatment groups in the incidence of any day or night time symptoms or any other outcome measures.

Topics: Administration, Inhalation; Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Bronchodilator Agents; Double-Blind Method; Female; Fluticasone; Gestational Age; Glucocorticoids; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lung Diseases; Male; Oxygen; Respiration Disorders

Fluticasone furoate (FF) is a novel enhanced-affinity glucocorticoid that has been developed as topical therapy for allergic rhinitis. The pharmacological properties of FF have been investigated using a number of in vitro experimental systems. FF demonstrated very potent glucocorticoid activity in several key pathways downstream of the glucocorticoid receptor (GR) as follows: the transrepression nuclear factor-kappaB (NF-kappaB) pathway, the transactivation glucocorticoid response element pathway, and inhibition of the proinflammatory cytokine tumor necrosis factor-alpha. Furthermore, FF showed the greatest potency compared with other glucocorticoids for preserving epithelial integrity and reducing epithelial permeability in response to protease- and mechanical-induced cell damage. FF showed a 30- to >330,000-fold selectivity for GR-mediated inhibition of NF-kappaB vs. the other steroid hormone receptors, substantially better than a number of other clinically used glucocorticoids. In studies examining the respiratory tissue binding properties of glucocorticoids, FF had the largest cellular accumulation and slowest rate of efflux compared with other clinically used glucocorticoids, consistent with greater tissue retention. The in vivo anti-inflammatory activity of FF was assessed in the Brown Norway rat ovalbumin-induced lung eosinophilial model of allergic lung inflammation. At a dose of only 30 microg, FF achieved almost total inhibition of eosinophil influx in the lung, an inhibition that was greater than that seen with the same dose of fluticasone propionate. In conclusion, the potent and selective pharmacological profile of FF described here could deliver an effective, safe, and sustained topical treatment of respiratory inflammatory diseases such as allergic rhinitis and asthma.

Topics: Androstadienes; Animals; Cell Line, Tumor; Cell Membrane Permeability; Chlorocebus aethiops; Disease Models, Animal; Epithelial Cells; Fluticasone; Glucocorticoids; Humans; Hypersensitivity; Inflammation; Lipopolysaccharides; NF-kappa B; Pancreatic Elastase; Rats; Rats, Inbred BN; Receptors, Steroid; Respiration Disorders; Tumor Necrosis Factor-alpha