pulmicort and Stomatitis

The present study was designed to observe the effects of 8 wk of treatment with formoterol (Foradil) 24 microgram, budesonide 400 microgram, and matched placebo inhaled twice a day on inflammatory indices in the bronchial mucosa of 64 patients with mild atopic asthma. Biopsies were obtained at the start and 1 wk before stopping a 9-wk period of treatment, and inflammatory cell numbers were assessed in the submucosa and epithelium by immunohistochemistry. Regular formoterol significantly reduced the number of submucosal mast cells, with a similar trend for eosinophils but not activated T cells. A subgroup analysis conducted in biopsies with >= 10 eosinophils per mm2 revealed a significant reduction in eosinophil numbers when compared with both pretreatment baseline (p < 0.01) and changes after placebo (p < 0.01). Parallel, but less pronounced, effects were observed on mast cell but not on CD25(+) T cell numbers. There was no effect of any of the three treatments on BAL levels of mast cell or eosinophil mediators. We conclude that regular treatment with inhaled formoterol reduces rather than increases inflammatory cells in the mucosa of asthmatic patients. It is possible that these cellular effects of formoterol may contribute to the therapeutic efficacy of this drug when used regularly in the treatment

Topics: Administration, Inhalation; Adolescent; Adult; Asthma; Bronchi; Bronchoalveolar Lavage Fluid; Bronchodilator Agents; Budesonide; Double-Blind Method; Ethanolamines; Female; Formoterol Fumarate; Humans; Male; Middle Aged; Nasal Mucosa; Placebos; Stomatitis

Topical drug delivery in the oral mucosa has its set of challenges due to the unique anatomical and physiological features of the oral cavity. As such, the outcomes of local pharmacological treatments in oral disorders can fail due to unsuccessfully drug delivery. Oral mucositis, a severe inflammatory and ulcerative side effect of oncological treatments, is one of such diseases. Although the damaged tissue is within reach, no approved topical drug treatment is available. Several strategies based on its physiopathology have been implemented and clinically used. Even so, results tend to lack or be insufficient to improve patient's quality of life. The use of corticosteroids has been employed in such strategies due to their strong anti-inflammatory action. Typically, these are administrated in simple liquid formulations, where the drug is dispersed or solubilized, lacking the ability to maintain local concentration. In this work, we propose the development of a biocompatible delivery system with boosted abilities of retention and control release of budesonide, a corticosteroid with an elevated ratio of topical anti-inflammatory to systemic action. Through spray-drying, polymeric particles of Chitosan and Eudragit® E PO were produced and characterized for the vectorization of this drug.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Cell Line; Chitosan; Drug Delivery Systems; Drug Liberation; Humans; Particle Size; Polymers; Polymethacrylic Acids; Stomatitis

Concomitant allergic reactions to multiple drugs are uncommon. We report the case of a 66-year-old woman who presented with concomitant sensitization to inhaled budesonide and oral nystatin presenting as allergic contact stomatitis and systemic allergic contact dermatitis. It is notable that one of the reactions was caused by oral nystatin, which generally is not considered to be allergenic due to its poor intestinal absorption. Diagnoses were confirmed on patch testing with histologic examination along with oral challenge testing. We also used challenge testing to rule out cross-reactivity among nystatin and other macrolide drugs, both antifungals and antibiotics.

Topics: Administration, Inhalation; Aged; Antifungal Agents; Budesonide; Candidiasis, Oral; Cough; Dermatitis, Allergic Contact; Female; Glucocorticoids; Humans; Nystatin; Stomatitis

Oral chronic graft versus host disease (cGVHD) is common and a major cause of morbidity and loss of quality of life in long term survivors. Cyclosporine with prednisone remains the first line therapy for oral manifestations of cGVHD. However, even with routine administration of systemic agents, many patients with oral manifestations of cGVHD do not have resolution of their disease and may benefit from incorporation of local therapy. Budesonide is a highly potent steroid which has minimal systemic side effects and being used for oral cGVHD. We designed a retrospective study to compare treatment results of patients with oral cGVHD who received topical budesonide in addition to systemic therapy that consists of combined prednisone and cyclosporine (Group A, n = 12), with the treatment results of patients who were administered the same systemic therapy alone (Group B, n = 11) to determine whether budesonide mouthwash had any advantage on response rates. Three mg topical budesonide/10 ml saline was used 3-4 times a day for up to 6 months in group A. Diagnosis, clinical staging, and treatment response scoring for cGVHD were performed according to National Institutes of Health (NIH) consensus criteria. At the baseline examination, there were no statistically significant differences in terms of median oral cGVHD examination scores between two groups. After treatment, there was statistically significant decrease in median oral cGVHD examination scores compared to baseline (P < 0.001 and 0.021), and significant differences were found between two groups (P < 0.032). Overall response rate was 83% and 36% for group A and B, respectively (P = 0.036). However, no statistically significant differences were found between median pain scores of two groups before and after treatment (P = 0.740 and P = 0.091). No major systemic side effects and oral candidiasis were observed in two groups of patients. We concluded that topical budesonide might be added to systemic therapy to obtain better response rates in patients with oral cGHVD.

Topics: Adult; Budesonide; Candidiasis, Oral; Chronic Disease; Cohort Studies; Cyclosporine; Drug Evaluation; Drug Therapy, Combination; Female; Graft vs Host Disease; Hematologic Neoplasms; Humans; Immunosuppressive Agents; Male; Middle Aged; Mouthwashes; Pain Measurement; Peripheral Blood Stem Cell Transplantation; Prednisone; Retrospective Studies; Sodium Chloride; Stomatitis; Transplantation Conditioning; Treatment Outcome

Despite the widespread use of corticosteroids on the mucous membranes of the nose, eye and bronchial tree, mucosal contact sensitivity has apparently been uncommon. However, since the introduction of new corticosteroids such as tixocortol pivalate and budesonide, mucosal contact sensitivity, particularly that affecting the nasal mucosa, has increasingly been reported. Contact allergy on other mucosal surfaces and in the bronchial tree is very rare. We report three women who had contact allergy to tixocortol pivalate or budesonide in nasal sprays, and one woman who had an allergic contact stomatitis from tixocortol pivalate in oral lozenges.

Topics: Administration, Intranasal; Administration, Oral; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Drug Eruptions; Female; Humans; Hydrocortisone; Hypersensitivity, Delayed; Pregnenediones; Stomatitis

Topics: Aerosols; Aged; Beclomethasone; Budesonide; Child; Female; Glucocorticoids; Humans; Male; Middle Aged; Mouth Mucosa; Pregnenediones; Stomatitis