Decreased Pulmonary Function in School Children in Western Japan after Exposures to Asian Desert Dusts and Its Association with Interleukin-8

The objective of the study was to investigate the influence of Asian dust storms (ADS) on pulmonary function of school children and the relationship of this effect with interleukin-8. Morning peak expiratory flow (PEF) was measured daily in 399 children from April to May 2012 and in 384 of these children from March to May 2013. The data were analyzed for an association between ADS events and PEF by linear mixed models. Interleukin-8 transcriptional activity was assessed in THP-G8 cells stimulated by airborne particles collected on ADS days. Seven ADS days were identified: April 23 and 24, 2012; March 8 to 10, 2013; and March 19 and 20, 2013. Changes in PEF after ADS exposure were −8.17 L/min (95% confidence interval, −11.40 to −4.93) in 2012 and −1.17 L/min (−4.07 to 1.74) in 2013, and there was a significant difference between 2012 and 2013. Interleukin-8 transcriptional activity was significantly higher in 2012 at10.6±2.9-fold compared to3.7±0.4in March 8 to 10, 2013, and2.3±0.2in March 19 and 20, 2013. The influence of ADS events on pulmonary function of children differs with each ADS event and may be related to interleukin-8 production.

New conception of combined drugs administration in therapy of bronchial asthma. The CONCEPT trial

The article is devoted to the improvement in therapy of bronchial asthma, namely to achievement and maintenance of the control of the disease using combined drugs containing inhaled steroids and long-acting β2-agonists. We used data of multi-center, randomised, double-blind, double-masking 1-year trial CONCEPT. We demonstrated advantages of therapy with fixed-dosed Seretid (fluticasone propionate / salmeterol) compared to flexible dosed Simbicort (budesonide / formoterol). As a result of this trial, the fixed-dosed Seretid was shown to provide more symptom-free days (medians, 73.8 % and 64.9 %, respectively, p = 0.03); days without emergency drug needed (94.5 % and 90.7 %, respectively, p = 0.008); better morning peak expiratory flow rate (the corrected mean, 9.5 L / min; 95%CI, 2.7–16.3, p = 0.006), approximately two-fold decrease in moderate to severe acute exacerbation rate compared to the flexible dosing of Simbicort (the corrected exacerbation rate per year, 0.18 and 0.33, p = 0.008). The total length of therapy with systemic steroids at the Seretid group was 46 % less than that at the Simbicort group (301 and 559 days, respectively, р = 0.026).

Fluticasone Propionate, 100 µg bid, Using a Non-CFC Propellant, HFA 134a, in Asthmatic Children

BACKGROUND: Secondary to phasing out chlorofluorocarbons (CFCs), the fluticasone propionate (FP) pressurized metered-dose inhaler has been formulated in a nonozone-depleting propellant, hydrofluoralkane (HFA) 134a.OBJECTIVES: To demonstrate equivalent efficacy and safety of FP 200 µg daily propelled by HFA 134a to FP 200 µg daily propelled by CFCs 11 and 12 over a four-week treatment period in pediatric asthmatic patients.METHODS: The study was multinational, randomized, double blind and of parallel group design. Eligible patients aged 16 years and younger were steroid naive or receiving 500 µg/day or less of beclomethasone dipropionate, budesonide or flunisolide, or 250 µg/day or less of inhaled FP. The primary efficacy variable was mean morning peak expiratory flow with equivalence determined if the 90% CIs for the treatment differences between groups were within ±15 L/min.RESULTS: Three hundred fifteen patients (mean age 9.3±2.8 years) were randomly assigned; 158 patients received FP HFA 134a and 157 patients received FP CFC. Over the four-week treatment period, mean morning peak expiratory flow increased from baseline in both groups (14 L/min and 17 L/min, respectively), with a mean treatment difference of -2 L/min. Equivalence was demonstrated between the groups (90% CI -6 to +3 L/min; P=0.589). Both formulations were well tolerated with no serious drug-related events.CCONCLUSIONS: FP propelled by HFA 134a has equivalent efficacy and comparable safety to FP propelled by CFC propellants at a microgram equivalent dose in pediatric asthmatic patients.

Inhaled budesonide for adults with mild-to-moderate asthma: a randomized placebo-controlled, double-blind clinical trial

CONTEXT: Budesonide is an inhaled corticosteroid with high topical potency and low systemic activity recommended in the treatment of chronic asthma. OBJECTIVE: This study was conducted to determine the efficacy and safety of inhaled budesonide via a breath-activated, multi-dose, dry-powder inhaler. TYPE OF STUDY: Multicenter randomized parallel-group, placebo-controlled, double-blind, clinical trial. SETTING: Multicenter study in the university units. PARTICIPANTS: Adult patients with mild-to-moderate asthma that was not controlled using bronchodilator therapy alone. PROCEDURES: Comparison of budesonide 400 µg administered twice daily via a breath-activated, multi-dose, dry-powder inhaler with placebo, in 43 adult patients (aged 15 to 78 years) with mild-to-moderate asthma (FEV1 71% of predicted normal) that was not controlled using bronchodilator therapy alone. MAIN MEASUREMENTS: Efficacy was assessed by pulmonary function tests and asthma symptom control (as perceived by the patients) and the use of rescue medication. RESULTS: Budesonide 400 µg (bid) was significantly more effective than placebo in improving morning peak expiratory flow (mean difference: 67.9 l/min; P < 0.005) and FEV1 (mean difference: 0.60 l; P < 0.005) over the 8-week treatment period. Onset of action, assessed by morning peak expiratory flow, occurred within the first two weeks of treatment. CONCLUSIONS: Budesonide via a breath-activated, multi-dose, dry-powder inhaler results in a rapid onset of asthma control, which is maintained over time and is well tolerated in adults with mild-to-moderate asthma.