ASSESSMENT OF INHALED LONG ACTING BETA2 AGONISTS AND OR INHALED CORTICOSTEROIDS IN THE TREATMENT OF PERSISTENT BRONCHIAL ASTHMA

SUMMARY AND CONCLUSIONSBronchial asthma is characterized by variable airflow obstruction, airway hyper-responsiveness and chronic airway inflammation and over the past 20 years the basic understanding asthma pathogenesis has rapidly evolved leading to development of noval therapies including inhaled corticosteroids, long acting beta agonists (LABA), agents that interfere leukotrine pathway and monoclonal anti IgE therapies.This study was carried out to evaluate inhaled corticosteroid and/or inhaled long acting beta-2 agonists and persistant bronchial asthma.This study included (44) patients with moderate persistent asthma after exclusion (10) patients who were controlled by 100-250 g bd of fluticasone.All patients were subjected to the following:(1) Thorough medical history.(2) Full clinical examination; general and local examination.(3) Plain chest and heart X-ray: postero-anterior and lateral view films to exclude any associated radiological abnormalities.(4) Spirometric pulmonary function tests using computerized spirometry (sensor medicus 2450) before and 20 minutes after inhalation of 4 puffs (400 mg) of salbutamol using (MDI) plus a spacer.The following parameters were obtained:• FEV1: Forced expiratory volume in the first second of the beginning of expiration as an absolute value and percentage of predicted for age, sex, length and weight.• FVC: Forced vital capacity, absolute value and percentage of predicted.• FEV1/FVC%.• PEFR; peak expiratory flow rate as absolute value and percentage of predicted.• FEF25-75% forced expiratory flow at 25-75% of predicted vital capacity.(5) Arterial blood gases analysis (ABGs):(6) Sputum induction and examination:Patients were classified into 3 groups:Group I: Patients received both LABA and ICS in one canister. In the form of Salmetrol and fluticasone dipropionate (50/250 g bd) via Diskus. This group comprised (15) patients non-smokers (6) males and (9) females with a mean age of (37.510.3).Group II: Patients received both LABA and ICS in two separate canisters. In the form of salmetrol (50 g) via Diskus and fluticasone (250 g bd) via Diskus. This group comprised (16) patients non-smokers (7) males and (9) females with a mean age of (33.17.1).Group III: Patients received ICS with doubling of the dose in the form of fluticasone dipropionate (500 g bd) via Diskus. This group comprised (13) patients non-smokers (6) males & (7) females with a mean age of (31.78.7).The results of this study showed the following:• There were non significant difference regarding historical data (age, sex, family history of atopy) of the patient in different studied groups.• Percentage of patients who developed exacerbations were lowest in group I and group II (20%, 25%) respectively, when compared to group III after 8 and 12 weeks of treatment.• There were significant difference regarding symptoms score of patients after 4 and 12 week of treatment in different studied groups, and significant improvement of symptoms score was detected in group I and II with no significant difference between both.• There were significant negative correlations between sputum eosinophils% and both FEV1% and PEF.• There were significant increment of FEV1 after 4 & 12 weeks of treatment in the different studied groups which was more obvious in group I and II when compared to group III, with no significant difference between group I and group II.• There were significant increment of PEF after 4 & 12 weeks of treatment in the different studied groups which was more obvious in group I and II when compared to group III, with no significant difference between group I and group II.• There were significant decrement of sputum eosinophils in induced sputum after 4 and 12 weeks of treatment in the different studied groups, but significant decrement of sputum eosinophils was detected in group III when compared to group I and II with no significant difference between group I and group II.• In group I and group II, FEV1 then PEF was the best parameter measured in response to therapy while sputum eosinophils was the best in group III.CONCLUSIONIt can be concluded that:* Combined use of inhaled low dose corticosteroids and long acting beta agonist improve the clinical outcome and decrease the severity of persistent asthma.* No significant difference between the concomitant and the separate use of inhaled low dose steroid and long acting beta agonist (LABA).* Increasing the dose of inhaled steroid although leads to decrease of sputum eosinophils (which could be considered as a marker of improved inflammation in asthmatic patients), it is less effective than combining small doses with long acting beta-2 agonists.RECOMMENDATIONStudy the effect of inhaled steroid in different doses with or without long acting beta-2 agonist on the histopathological changes in asthmatic airways.