pulmicort and Contusions

High-dose inhaled corticosteroids (ICS) have been associated with the same side-effects as oral corticosteroids. Beclomethasone dipropionate (BDP) and budesonide (BUD) in doses greater than 2000 microg/day are used regularly in severe asthma, despite the fact that safety and efficacy data at such high doses are limited. Fluticasone propionate (FP) has been promoted as being twice as potent clinically as BDP or BUD at doses of 2000 microg/day or less with a similar safety profile. The aim of this study was to compare the efficacy and safety of FP with BDP and BUD in 133 symptomatic adult asthmatics requiring at least 1750 microg/day of BDP or BUD.. Patients fulfilling the entry criteria were randomized to receive either their regular ICS medication or FP at approximately half the microgram dose for 6 months in an open, parallel group study. The primary efficacy measure was based on morning peak expiratory flow measurements recorded by patients on daily record cards, while determination of safety was based on a number of endpoints including changes in bone turnover indices, the incidence of topical side-effects and assessments of quality of life.. It was shown that patients who were switched to FP, but not those continuing with BDP or BUD, had significant increases in levels of morning serum cortisol and the urine cortisol:creatinine ratio while maintaining asthma control. Serum osteocalcin and the pyridinoline:creatinine ratio, as well as the deoxypyridinoline:creatinine ratio, were also shown to increase only in the FP group. Subjective assessments such as quality of life score, the incidence and ease of bruising, and reports of hoarseness also favoured the FP group.. It is concluded that, at the doses studied and with the delivery devices used clinically, FP is at least as effective as BDP/BUD in the management of severe asthma and may offer clinical advantages with respect to steroid-related adverse effects.

Topics: Adult; Androstadienes; Asthma; Beclomethasone; Biomarkers; Budesonide; Chronic Disease; Contusions; Creatinine; Female; Fluticasone; Glucocorticoids; Hoarseness; Humans; Hydrocortisone; Male; Middle Aged; Osteocalcin; Quality of Life

In our study, we aimed to investigate the anti-inflammatory mediator effects of budesonide (BS), an inhaled corticosteroid and interleukin-10 (IL-10) on a pulmonary contusion in an experimental rat model in which an isolated bilateral pulmonary contusion was created by blunt thoracic trauma.. Fifty-five male Sprague-Dawley rats were used in the study. Sham, control, BS and IL-10 groups were created. A pulmonary contusion was created by performing isolated blunt thoracic trauma in all groups except for the sham group. The trauma's severity was determined as 1.45 J. BS and IL-10 were administered orogastrically to the respective groups 30 min before trauma, and orogastrically and intraperitoneally, respectively, on the first and second days after the trauma. Only the blunt thoracic trauma was performed for the control group. SatO(2), PaO(2) and PaCO(2), blood glutathione, malondialdehyde (MDA) and tumour necrosis factor-α (TNFα) values were recorded on the zeroth, first, second and third days. The histopathological examination and the bronchoalveolar lavage cell count were performed on pulmonary tissues.. Blood gas analysis revealed that SatO(2) and PaO(2) values on the first and second days were significantly lower in the control, BS and IL-10 groups compared with the sham group (P < 0.05). The SatO(2) and PaO(2) values on the third day in the BS and IL-10 groups were higher than in the control group (P < 0.05). The mean MDA in the control group was higher than in the sham, BS and IL-10 groups (P < 0.05). The mean TNFα in the control group was higher than in the sham, BS and IL-10 groups (P < 0.05). Pulmonary pathology scoring in the control group was observed to be higher than in the sham, BS and IL-10 groups (P < 0.05).. In this rat experiment model in which an isolated pulmonary contusion was created by blunt trauma, BS and IL-10 were observed to reduce contusion severity in the lung and minimize the inflammatory reaction.

Topics: Analysis of Variance; Animals; Anti-Inflammatory Agents; Bronchoalveolar Lavage Fluid; Budesonide; Carbon Dioxide; Contusions; Disease Models, Animal; Glutathione; Histology; Interleukin-10; Lung; Male; Malondialdehyde; Oxygen; Rats; Rats, Sprague-Dawley; Thoracic Injuries; Tumor Necrosis Factor-alpha; Wounds, Nonpenetrating

We assessed the effect of long-term treatment with inhaled budesonide (BUD) on the occurrence of posterior subcapsular cataracts (PSC), bruises and hoarseness in children with asthma. Slit lamp examinations were performed in 157 asthmatic children treated with inhaled BUD at a mean daily dose of 504 microg (range 189-1,322 microg) for 3-6 yrs (mean 4.4 yrs). Measurements were compared with 111 age-matched children with asthma, who had never received treatment of exogenous corticosteroids (control group). The children were examined for bruises, their tendency to bruise and occurrence of voice changes. No incidents of PSC ascribable to BUD treatment were seen. One patient in the BUD group had been diagnosed with PSC before the study and this was still present. There were no statistically significant differences in number of bruises between the two groups (BUD=33, controls=3.2; p=0.70), area covered by bruises (BUD=10 cm2, controls=10.1 cm2; p=0.97), tendency to bruise (BUD=5/10, controls=5/10) or occurrence of hoarseness (BUD=20%, controls=21%; p=0.92). Furthermore, there was no correlation between the occurrence of bruises or tendency to bruise and duration of treatment, accumulated or current dose of BUD. A 3-6 yr treatment of children with inhaled budesonide at an average daily dose of about 500 microg is not associated with an increased occurrence of posterior subcapsular cataract, bruises, tendency to bruise, hoarseness or other noticeable voice changes.

Topics: Administration, Inhalation; Anti-Inflammatory Agents; Asthma; Bronchodilator Agents; Budesonide; Cataract; Child; Child, Preschool; Contusions; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Hoarseness; Humans; Long-Term Care; Male