ABSTRACT
Inhaled steroids are increasingly used in the management of asthma and although effective, they may cause systemic side effects. Theophylline is among the least expensive drugs used to treat asthma and consequently it remains a commonly used drug for this indication in many countries. In industrialized countries, the advent of inhaled corticosteroids, beta-2 agonists, and leukotriene modifying drugs has significantly diminished the extent to which theophylline is used. In addition to their bronchodilating effects, long acting inhaled beta2 agonists have recently been shown to have some anti-inflammatory properties. This work was designed to study the anti inflammatory effects of salmeterol compared to beclomethasone and theophylline by measuring of serum levels of tumor necrosis factor-alpha [TNF-alpha] and eosinophilic cationic protein [ECP] in children with mild and moderate to severe asthma. The study was carried out in The Chest and Allergy Unit, Pediatric Department, Tanta University Hospital, from October 2000 to January 2003. It comprised ninety asthmatic children who were presented by mild, and moderate to severe attack of asthma exacerbations, their ages ranged from 6-15 years. The asthmatic children were classified into 2 groups: Group I: Included thirty children with mild asthmatic attack with FEV1 of 70-80% of the expected normal value for age and sex at the time of presentation. These patients were subdivided into three sub-groups to receive one of the following drugs for eight weeks: Inhaled beclomethasone dipropionate by metered dose inhaler [MDI] in a dose of 200 microgram / 8 hours [Steroid subgroup-I], oral sustained-release theophylline in a dose of 15 mg / kg / day [12 Hourly] [Theophylline subgroup-I], and Inhaled long acting beta 2 agonist [Salmeterol] by MDI in a dose of 50 microgram [2 buffs] / 12 hours [Salmetemi subgroup-I]. Group II: Included sixty children with moderate to severe asthma exacerbation with FEV1 less than 70% of the expected values for the age and sex. Conventional therapy was given as required to these patients to control the exacerbations of the asthmatic attack, and to achieve FEV1 of 70-80% of the expected normal values of their age and sex. Then the patients were subdivided to three sub-groups [Steroid subgroup-Il, Theophylline subgroup-Il, and Salmeterol subgroup-Il] to receive either one of the three drug modalities by the same dose and for the same duration as mentioned before in children with mild asthma [group I]. Absolute eosinophilic count [AEC], serum levels of eosinophilic cationic protein [ECP] and tumor ncrosis factor-alpha [TNF-alpha] were measured at presentation during the acute exacerbation and 8 weeks after beginning of the different treatment modalities. We concluded that beclomethasone dipropionate had effectively diminished serum levels of TNF-alpha and ECP to a greater extent than the Ophylline and salmeterol in children with bronchial asthma. Long acting theophylline also diminished significantly serum levels of TNF-alpha and ECP at a lower than customarily recommended blood theophylline level after 8 weeks of regular treatment. On the other hand, salmeterol decreased serum levels of TNF-alpha and ECP in asthmatic children but this reduction was not significant after 8 weeks of regular administration in cases of mild and moderately severe asthma