Effects of inhaled fluticasone and oral prednisolone on clinical and inflammatory parameters in patients with asthma

Background-Guidelines state that oral and inhaled corticosteroids are the c ornerstone of asthma treatment. The effect of both types of treatment can b e assessed by measuring lung and systemic parameters. Treatment far two wee ks with either oral prednisolone (30 mg/day), high dose fluticasone propion ate (2000 mu g/day, FP2000), or lower dose FP (500 mu g/day, FPS00), both g iven by a dry powder inhaler, were compared. Methods-One hundred and twenty patients with asthma were treated for two we eks in a double blind parallel group design. Lung function, asthma symptoms , airway hyperresponsiveness (PC20 methacholine and adenosine-5'-monophosph ate), sputum eosinophil and eosinophilic cationic protein (ECP) levels were measured as lung parameters. Ln addition, morning serum blood. cortisol, b lood eosinophil, and serum ECP levels were measured as systemic parameters. Results-PC20 methacholine and adenosine-5'-monophosphate showed significant ly greater improvement with FP2000 (1.99 and 4.04 doubling concentrations ( DC), respectively) than prednisolone (0.90 DC, p = 0.02; 2.15 DC, p = 0.05) and marginally more than with FP500 (1.69 and 3.54 DC). Changes in sputum eosinophil and ECP concentrations showed similar trends; the decrease in EC P was significantly greater with FP2000 than with FP500. In contrast, the s ystemic parameters of steroid activity (cortisol, peripheral blood eosinoph ils, and serum ECP) decreased to a similar extent with FP2000 and prednisol one but significantly less with FP500. Conclusions-Oral prednisolone (30 mg/day) was inferior to FP2000 in improvi ng airway hyperresponsiveness to both methacholine and AMP: with similar tr ends in forced expiratory volume in one second (FEV1)(3) sputum eosinophil and ECP concentrations. Systemic effects were similar with prednisolone and FP2000 and less with FP500.