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Allergologia et Immunopathologia
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Inicio Allergologia et Immunopathologia The efficacy of single-high dose inhaled corticosteroid versus oral prednisone t...
Journal Information
Vol. 44. Num. 2.March - April 2016
Pages 97-188
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Vol. 44. Num. 2.March - April 2016
Pages 97-188
Original Article
DOI: 10.1016/j.aller.2015.05.006
The efficacy of single-high dose inhaled corticosteroid versus oral prednisone treatment on exhaled leukotriene and 8-isoprostane levels in mild to moderate asthmatic children with asthma exacerbation
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O. Keskina,
Corresponding author
okeskin@gantep.edu.tr
okeskin02@yahoo.com

Corresponding author at: Department of Pediatric Allergy and Immunology, Medical Faculty, Gaziantep University, 27310, Gaziantep, Turkey.
, U. Ulucab, M. Keskinb, B. Gogebakanc, E. Kucukosmanoglua, M.Y. Ozkarsa, S. Kuld, H. Bayramc, Y. Coskunb
a Department of Pediatric Allergy and Immunology, Gaziantep University School of Medicine, Gaziantep, Turkey
b Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey
c Department of Pulmonology, Gaziantep University School of Medicine, Gaziantep, Turkey
d Department of Biostatistics, Gaziantep University School of Medicine, Gaziantep, Turkey
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Table 1. Main characteristics of the study population at the time of asthma exacerbation.
Abstract
Background

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.

Methods

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) (4000μg) or P and after six days of treatment with FP-1000μg/day or P. Cys-LTs and 8-isoprostane concentrations were determined using a specific immunoassay kit.

Results

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-1000μg/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.

Conclusions

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.

Keywords:
Asthma exacerbation
Children
Cysteinyl leukotrienes
Exhaled breath condensate
Inhaled corticosteroids
8-Isoprostane
Oral prednisone
Oxidative stress
Abbreviations:
ICS
Cys-LTs
EBC
PEF
FEV1
ELISA
FP
P
BAL

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