EFFECT OF SHORT-TERM TREATMENT WITH LOW-DOSE INHALED FLUTICASONE PROPIONATE ON AIRWAY INFLAMMATION AND REMODELING IN MILD ASTHMA - A PLACEBO-CONTROLLED STUDY

In a double-blind, parallel-group study, we examined the effect of sho rt-term treatment with inhaled fluticasone propionate (FP) in a group of 20 nonsmoking asthmatic patients who required only beta(2)-agonists to control their symptoms. We administered FP (250 mu g twice daily) or matched placebo for 6 wk. Methacholine challenge was performed befo re treatment, after 3 wk, and at the end of treatment. Each patient un derwent bronchoscopy with bronchoalveolar ravage (BAL) and bronchial b iopsy before and after treatment. Eight patients in the placebo group and nine patients in the FP group completed the study. Bronchial respo nsiveness to methacholine decreased significantly only after 6 wk of t reatment with FP (p < 0.05). When we compared the FP group with the pl acebo group, we observed a significant decrease only in the number of cells expressing intracellular adhesion molecule-1 (ICAM-1) and MAC-1 (p < 0.04 and p < 0.03, respectively). Moreover, we saw that the trypt ase level in BAL decreased (p < 0.001), whereas the eosinophil cationi c protein (ECP) level did not change significantly. Additionally, the number of eosinophils and mast cells in the lamina propria in bronchia l biopsies specimens was significantly smaller in the FP group than in the placebo group (p < 0.02 and p < 0.01, respectively). Additionally , in the FP group, we found that basement-membrane thickness was signi ficantly decreased when compared with that of the placebo group (p < 0 .05). In conclusion, our results show that short-term treatment with l ow-dose FP reduces inflammatory cell infiltration into the lamina prop ria in bronchial biopsy specimens. Moreover, short-term low-dose FP tr eatment might control the intensity of airway remodeling in mild asthm a.