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 cornerstone of asthma treatment. The effect of both types of treatment can be assessed by measuring lung and systemic parameters. Treatment far two weeks with either oral prednisolone (30 mg/day), high dose fluticasone propionate (2000 mu g/day, FP2000), or lower dose FP (500 mu g/day, FPS00), both given by a dry powder inhaler, were compared. Methods-One hundred and twenty patients with asthma were treated for two weeks in a double blind parallel group design. Lung function, asthma symptoms, airway hyperresponsiveness (PC20 methacholine and adenosine-5'-monophosphate), sputum eosinophil and eosinophilic cationic protein (ECP) levels were measured as lung parameters. Ln addition, morning serum blood. cortisol, blood eosinophil, and serum ECP levels were measured as systemic parameters. Results-PC20 methacholine and adenosine-5'-monophosphate showed significantly 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 ECP was significantly greater with FP2000 than with FP500. In contrast, the systemic parameters of steroid activity (cortisol, peripheral blood eosinophils, and serum ECP) decreased to a similar extent with FP2000 and prednisolone but significantly less with FP500. Conclusions-Oral prednisolone (30 mg/day) was inferior to FP2000 in improving airway hyperresponsiveness to both methacholine and AMP: with similar trends 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