Keskin O, Uluca U, Keskin M, Gogebakan B, Kucukosmanoglu E, Ozkars M Y, Kul S, Bayram H, Coskun Y
Department of Pediatric Allergy and Immunology, Gaziantep University School of Medicine, Gaziantep, Turkey.
Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey.
Allergol Immunopathol (Madr). 2016 Mar-Apr;44(2):138-48. doi: 10.1016/j.aller.2015.05.006. Epub 2015 Aug 28.
The anti-inflammatory effect of high-dose inhaled corticosteroids (ICS) in children with asthma exacerbation is unknown. We aimed to investigate the efficacy of single-high dose ICS versus oral prednisone treatment followed by a course of six day high-dose ICS or oral prednisone (P) treatment on the concentrations of Cys-LTs and 8-isoprostane levels in the exhaled breath condensate (EBC) of children with asthma exacerbation.
Ninety-four children with moderate-severe asthma exacerbation were evaluated with asthma scores, peak expiratory flow rate (PEF), forced expiratory volume in first second (FEV1) and exhaled Cys-LT and 8-isoprostane levels before and after treatment. EBC was collected from 52 patients before and four hours after treatment with inhaled fluticasone propionate (FP) (4000 μg) or P and after six days of treatment with FP-1000 μg/day or P. Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.
Both single high-dose FP (n=59) and p (n=35) treatment resulted in a significant improvement in asthma score (p<0.0001), PEF (p<0.0001), and FEV1 (p<0.0001). Cys-LT concentration in the EBC decreased significantly both after the initial treatment (p=0.001), and at the end of the six-day period in the FP group (p<0.0001). 8-Isoprostane concentration was lower only after six days of treatment with FP-1000 μg/day in the FP group (p=0.023). There was a significant decrease in exhaled Cys-LTs after four hours (p=0.012) and six days of P treatment (p=0.018) in children with asthma exacerbation.
High-dose ICS treatment may be useful in the treatment of children with asthma exacerbation. The effects start as early as after four hours. The suppression of Cys-LTs production contributes to the early effects. Suppression of both Cys-LTs and oxidants may favourably contribute to the effects observed later.
高剂量吸入性糖皮质激素（ICS）对哮喘急性发作儿童的抗炎作用尚不清楚。我们旨在研究单次高剂量ICS与口服泼尼松治疗，随后进行为期6天的高剂量ICS或口服泼尼松（P）治疗，对哮喘急性发作儿童呼出气冷凝液（EBC）中半胱氨酰白三烯（Cys-LTs）和8-异前列腺素水平的影响。
对94例中重度哮喘急性发作儿童在治疗前后进行哮喘评分、呼气峰值流速（PEF）、第1秒用力呼气容积（FEV1）以及呼出Cys-LTs和8-异前列腺素水平评估。在52例患者中，于吸入丙酸氟替卡松（FP）（4000μg）或P治疗前及治疗后4小时，以及在FP 1000μg/天或P治疗6天后采集EBC。使用特定免疫分析试剂盒测定Cys-LTs和8-异前列腺素浓度。
单次高剂量FP（n = 59）和P（n = 35）治疗均使哮喘评分（p < 0.0001）、PEF（p < 0.0001）和FEV1（p < 0.0001）有显著改善。初始治疗后（p = 0.001）以及FP组6天疗程结束时（p < 0.0001），EBC中Cys-LT浓度均显著下降。仅在FP组中，FP 1000μg/天治疗6天后8-异前列腺素浓度降低（p = 0.023）。哮喘急性发作儿童在P治疗4小时（p = 0.012）和6天（p = 0.018）后呼出Cys-LTs显著下降。
高剂量ICS治疗可能对哮喘急性发作儿童有效。其效果早在4小时后就开始显现。Cys-LTs生成的抑制促成了早期效果。Cys-LTs和氧化剂的抑制可能对后期观察到的效果有积极作用。
