Comparison of the efficacy of inhaled fluticasone propionate with triamcinolone acetonide in children with moderate persistent asthma

Inhaled corticosteroids are the most effective therapy available today for children and adults with chronic asthma. There have been relatively few stu dies comparing inhaled steroids in children. In a 2-year crossover study, w e compared the efficacy of inhaled fluticasone propionate (FP), 880 mu g/d (2 puffs of 220 mu g per puff) administered twice daily, with that of triam cinolone acetonide (TA), 900 mu g/d (3 puffs of 100 mu g per puff administe red 3 times a day). Nine children with moderate persistent asthma, with a m ean age of 13 years (range, 10-18 years) and a mean duration of asthma of 8 years, initially received TA, 900 mu g/d, for 1 year and then were switche d to FP, 880 mu g/d, and followed for an additional year. Pulmonary functio n tests (PFTs) were monitored and analyzed before and after the switch for the duration of the study. Mean percentages of those predicted for age valu es for forced expiratory volume in 1 second (FEV1), forced expiratory flow between 25 and 75% of vital capacity (FEF25-75%), and peak expiratory flaw rate (PEFR) were compared at 1-month, 2 to 6-month, and 7 to 12-month inter vals. The number of asthma exacerbations, emergency room visits, hospital a dmissions, and school days lost were also compared. There was significant i mprovement in mean asthma exacerbations per patient per year while patients were receiving FP (4.88 +/- 2.93 SD vs. 2.33 +/- 2.06 SD; p < 0.05). There was a trend towards improvement in the number of emergency room visits, ho spital admissions, and school days lost while patients were on FP, but the difference was not significant. A significant improvement in mean percentag e of those predicted for age values for FEV1 was noted while patients were receiving FP (p < 0.05 for all three periods). The mean percentage of that predicted for age values for FEF25-75% significantly improved at 1 month af ter the switch, but there were no significant differences during the 2 to 6 -month and 7 to 12-month periods. FP, 880 mu g/d, improved lung function an d decreased the number of asthma exacerbations in adolescents with moderate persistent asthma when compared with a similar dosage of TA.