Scientific rationale for the possible inhaled corticosteroid intraclass difference in the risk of pneumonia in COPD.

Inhaled corticosteroids (ICSs) treatment combined with long-acting ß2-adrenoceptor agonists (LABAs) reduces the risk of exacerbations in COPD, but the use of ICSs is associated with increased incidence of pneumonia. There are indications that this association is stronger for fluticasone propionate than for budesonide. We have examined systematic reviews assessing the risk of pneumonia associated with fluticasone propionate and budesonide COPD therapy. Compared with placebo or LABAs, we found that fluticasone propionate was associated with 43%-78% increased risk of pneumonia, while only slightly increased risk or no risk was found for budesonide. We have evaluated conceivable mechanisms which may explain this difference and suggest that the higher pneumonia risk with fluticasone propionate treatment is caused by greater and more protracted immunosuppressive effects locally in the airways/lungs. These effects are due to the much slower dissolution of fluticasone propionate particles in airway luminal fluid, resulting in a slower uptake into the airway tissue and a much longer presence of fluticasone propionate in airway epithelial lining fluid.

Pattern of corticosteroid allergy in Thailand.

BACKGROUND: Corticosteroid allergy is a complication of topical therapy detected by patch-testing with corticosteroid allergens. OBJECTIVE AND METHODS: Ten-year retrospective review to study the prevalence and patterns of corticosteroid allergy in Thai patients. RESULTS: Of 882 patients who were patch-tested, 29 (3.29%) had allergic reactions to corticosteroids. Of these 29 patients, 17 (58.62%) had positive reactions to one corticosteroid, and 12 (41.38%) reacted to multiple corticosteroids. Rates of reaction to corticosteroid groups ranged from 31.03 to 80.95%. Concomitant reactions between groups were noted. The prevalence of topical corticosteroid allergy (using two screening allergens, tixocortol pivalate and budesonide) was 2.27% (20 of 882). Testing with additional steroid allergens in suspected cases increased the prevalence to 3.29%. Tixocortol pivalate detected 51.72% of corticosteroid-allergic cases, and budesonide detected 24.14%. Combining both tixocortol and budesonide detected 68.97% of cases. CONCLUSION: Corticosteroid allergy is found to multiple corticosteroids, and concomitant reactions occur across groups. Group D1 corticosteroid esters produced a higher positive reaction rate (61.9%) than groups D2 (52.38%) and A (51.72%). This may be due to different prescribing habits or the easy access to D1 corticosteroids sold over the counter by pharmacies in Thailand.

Calidad de vida en niños asmáticos de Cuba y México que utilizan esteroides inhalados / Quality of life in asthmatic children in Cuba and México that use inhaled steroids

Objetivo: Valorar el impacto en la calidad de vida de furoato demometasona, beclometasona y budesonida en pacientes asmáticos de las ciudades de Tehuacán y Camagüey. Material y método: Se asignaron aleatoriamente 80 niños asmáticos de ambas ciudades a casos y controles. Los primeros recibieron tratamiento con uno de los siguientes esteroides: furoato de mometasona 400 micro g, beclometasona 400 micro g, obudesonida 400 micro g. Los controles recibieron tratamiento a demanda. Todos fueron evaluados según los cuestionarios de calidad de vida SF-36 y AQLQ. Se determinaron las medias y se compararon antes y después utilizando la prueba de la t de Student. Se hizo un análisis de regresión para la correlación entre los resultados de ambos cuestionarios; se determinó la fuerza de asociación mediante la odds ratio (OR), y se eligió para el cuestionario SF-36 a los pacientes con mejor calidad de vida y para el AQLQ a los que habían incrementado 5 o más puntos en los ítems. Resultados: Mejoraron la calidad de vida 52 pacientes (p<0,05); de ellos, 31 utilizaron esteroides inhalados (OR= 3,11; intervalo de confianza [IC] del 95%: 1,18-8,19). La OR para Camagüey fue de 3,2 (IC del 95%: 0,7-14,9) y para Tehuacán de3,3 (IC del 95%: 1,08-10,4). En la comparación de medias entre muestras pareadas se observaron diferencias estadísticamente significativas para el SF-36 (p= 0,006) y el AQLQ (p <0,05). La correlación entre los resultados de ambos cuestionarios al final fue de 0,53 (p= 0,015).Conclusiones: La correlación entre los resultados de ambos cuestionarios al final del tratamiento fue significativa. Los asmáticos de Camagüey que recibieron dipropionato de beclometasona tenían una calidad de vida 2,2 veces más elevada que los que no la recibieron; los pacientes de Tehuacán que recibieron furoato de mometasona o budesonida disfrutaron de una calidad de vida 3,3 veces más elevada que los que no empleaban estos fármacos (AU)

Objective: To value the impact on life quality given by mometasonefuroate, beclomethasone and budesonide treatment in asthmatic patients from the cities of Tehuacán and Camagüey. Method and materials: 80 asthmatic children from both cities were randomly assigned to controls and cases. The first ones received treatment with one of the following steroids: mometasone furoate 400 micreg, beclomethasone 400 micreg or budesonide 400 micreg. Controls received treatment on demand. All of them were evaluated according to SF-36 and AQLQ quality of life scores. Averages were determined and they were comparedto each other before and after that, using the T of student test. A regression analysis was made for correlation between the results from both questionnaires. The association force was determined by odds ratio (OR), being chosen for theSF-36 questionnaire the patients who had the best quality of life and for the AQLQ those ones who had increased 5 points or more on the items. Results: 52 patients improved life quality (p <0.05); from them, 31 used inhaled steroids (OR 3,11; confidence interval [CI] of 95%: 1.18-8.19). The OR for Camagüey was 3.2 and CI of95%: 0.7-14.9 and for Tehuacán OR 3.3; IC of 95%: 1.08-10.4.In the comparison of averages between paired samples a statistically significant difference exist p= 0.006 for SF-36 and p <0.05 for AQLQ. The correlation between both questionnaires results at the end was 0.53 (p= 0.015). Conclusions: The correlation between the results of both questionnaires at the end of the treatment was significant. The asthmatic patients from Camagüey who used beclomethasone dipropionate have a quality of life increased in 2.2 times, comparing with those who do not use it. Those from Tehuacán who used beclomethasone dipropionate or budesonide enjoyed a 3.3 times higher quality of life than those who do not use it (AU)