You are here

Home » Content

YÜKSEK DOZ İNHALE FLUTICASONE PROPİONATE VE BUDESONİDE'İN ASTIMLI HASTALARDA SİSTEMİK YAN ETKİ POTANSİYELLERİNİN KARŞILAŞTIRILMASI

Comparison of potential for systemic side effects with high dose inhaled fluticasone propionate and budesonide in asthmatic patients

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2000

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Background: In our study, we aimed to compare the potential for systemic side effects of two most frequently preferred inhaled corticosteroids (CS) in the treatment of asthma, Fluticasone Propionate (FP) and Budesonide (B), by evaluating morning plasma Cortisol levels. Materials and method: The study included 69 moderate-persistent and severe asthmatic patients using minimal 1000 meg/day FP (n=33) or B (n=36) for at least 6 months. The mean age of the patients was 49.2*15.2 years in the f group using FP, and was 48.1*12.2 years (p>0.05) in the Td group using B. Patients were not utilizing any systemic drugs for the last 20 days and their morning plasma Cortisol level measurements were performed between 08.00 and 09.00 a.m. Results: Mean plasma Cortisol level of the f' group was 10.3*4.6 mcg/dl and that of the 2nd group was 10.4*5.4 mcg/dl (pzO.05). Mean plasma Cortisol level of the age matched healthy hospital personeli was 16.0*5.3 mcg/dl and the mean Cortisol level of the f group was significantly lower than the control group (pO.Ol). Four patients (12.1%) in the f group and six patients (16.7%) in the 2"1 group had extremely low plasma Cortisol levels, but such low levels were not measured in the control group at all. Conclusion: We could not define any difference between asthmatic patient groups utilising FP and B regarding their potentials for systemic side effects (p>0.05); on the other hand 12.1 % of the patients utilising FP and 16.7 % of the patients utilising B had extremely low plasma levels of Cortisol, which could lead to clinically important outcomes. We think that early morning plasma Cortisol levels should be measured at certain intervals in patients utilising high dose of inhaled CS to detect the patients vulnerable to systemic side effects.
Bookmark/Search this post with
Abstract (Original Language): 
Amaç: Çalışmamızda astım tedavisinde en çok tercih edilen inhale kortikosteroidler (KS) olan Fluticasone Propionate (FP) ve Budesonide (B)'in sistemik yan etki yapma potansiyellerini sabah ölçülen plazma kortizol düzeylerine bakarak karşılaştırmayı amaçladık. Materyal ve Metot: Çalışmaya en az 6 aydır minimum 1000 mcg/gün inhale FP (n=33) veya B (n=36) kullanan toplam 69 orta-persistan veya ilen evre astımlı hasta dahil edildi. Bulgular: FP kullanan 1. gruptaki hastalann yaş ortalaması 49.2*15.2 yıl, B kullanan 2. gruptaki hastaların yaş ortalaması ise 48.1X12.2 yıl idi (p>0.05). Hastaların tamamı en az 20 gündür hiçbir sistemik ilaç kullanmıyordu. Sabah kortizol düzeyi ölçümleri 08.00 ve 09.00 arasında yapıldı. Birinci grubun ortalama sabah kortizol değeri 10.3*f.6 mcg/dl, 2. grubunki ise 10.4*5.4 mcg/dl seviyesindeydi (pX).OS). Kontrol grubu olarak alınan 20 kişilik herhangi bir ilaç kullanmayan yaşça benzer sağlıklı hastane personelinin ortalama sabah kortizol düzeyi ise 16.0*5.3 mcg/dl olup, 1. grubun ortalama kortizol düzeyleri kontrol grubuna göre istatistiki olarak anlamlı derecede düşüktü (pO.Ol). 1. gruptaki 4 hastanın (%12.1), 2. gruptaki 6 hastanın (%16.7) sabah plazma kortizol düzeyleri klinik olarak önemli sonuçlar doğurabilecek kadar düşük ölçülürken, kontrol grubunda bu derecede düşük bir değere rastlanmadı. Çalışmamızda yüksek doz inhale FP ve B kullanan astımlı hasta grupları arasında sistemik yan etkilere yol açma potansiyeli açısından fark bulunmazken (p>0.05); FP kullanan hastaların %12.1'inde ve B kul/ananların ise %16.7'sinde ciddi klinik sonuçlar doğurabilecek derecede düşük kortizol seviyeleri tesbit edildi. Sonuç: Biz bu tip yüksek doz inhale steroid kullanan ve sistemik yan etkilere karşı hassas hastalann önceden saptanabilmesi amacı ile belli aralıklarla sabah kortizol düzeylerinin ölçülmesi gerektiğini düşünüyoruz.
FULL TEXT (PDF): 
PDF icon arastirmax-yuksek-doz-inhale-fluticasone-propionate-budesonidein-astimli-hastalarda-sistemik-yan-etki-potansiyellerinin-karsilastirilmasi.pdf
  • 2
125-128
  • Turkish

REFERENCES

References: 

1. Pauwels R. The current place of nedocromil in the treatment of asthma. J Allergy Clin Immunol 1996; 98: 151 6.
2. O'Byrne PM, Pedersen S. Measuring efficacy and safety of different inhaled corticosteroid preparations. J Allergy Clin Immunol 1998; 102: 879 86.
3. Barnes NC, Marone G, Di Maria GU, et al. A comparison of fluticasone propionate, 1 mg daily, with beclomethasone dipropionate, 2 mg daily, in the treatment of severe asthma. Eur Respir J 1993; 6: 877 84.
4. Kamada AK, Szefler SJ, Martin PJ, et al. Issues in the use of inhaled glucocorticoids. Am J Respir Crit Care Med 1996; 153: 1739 48.
5. Barnes JB, Pedersen S. Efficacy and safety of inhaled inhaled corticosteroids in asthma. Am Rev Respir Dis 1993; 148: 1 26.
6. Derom E, Schoor JV, Verhaeghe W, et al. Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma. Am J Respir Crit Care Med 1999; 160: 157 61.
7. Wales D, Makker H, Kane J, et al. Systemic bioavailability and potency of high dose inhaled corticosteroids. Chest 1999; 115: 1278 84.
8. Çöplü L, Sivri A, Barış Yİ. Effect of long term use of inhaled corticosteroid on bone mineral density in asthmatic women. ERS Kongresi 1997; P2247: 350s.
9. Abuekteish F, Kirkpatrick JNP, Russel G. Posterior subcapsular cataract and inhaled corticosteroid theraphy. Thorax 1995; 50: 674 76.
10. Cumming RG, Mitchell P, Leeder SR. Use of inhaled corticosteroids and the risk of cataracts. N Eng J Med 1997; 337: 8 14.
11. Garbe E, LeLorier J, Boivişn JF, et al. Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open angle glaucoma. JAMA 1997; 227: 722 7.
12. Capewell S, Reynolds S, Shuttleworth D, et al. Purpura and dermal thinning associated with high dose inhaled corticosteroids. Br Med J 1990; 300: 1548 51.
13. Ferguson AC, Spier S, Manjra A, et al. Efficacy and safety of high dose inhaled steroids in children with asthma. J Pediatr 1999; 134: 422 7.
14. Sorkness CA. Establishing a theurapeutic for the inhaled corticosteroids. J Allergy Clin Immunol 1998; 102: 52 64.
15. Wilson AM, Clark DJ, Devlin MM, et al. Adrenocortical activity with repeated administration of one daily inhaled fluticasone propionate and budesonide in asthmatic adults. Eur J Clin Pharmacol 1998; 53: 317 20.
16. Clark DJ, Grove A, Cargill RI, Lipworth BJ. Comperative adrenal suppression with inhaled budesonide and fluticasone propionate in adult asthmatic patients. Thorax 1996; 51: 262 6.
17. Heinig JH, Boulet LP, Croonenborghs L, Mollers MJ. The effect of high dose fluticasone propionate and budesonide on lung function and asthma exacerbations in patients with severe asthma. Respir Med 1999; 93: 613 20.
18. Pauwels RA, Yernault JC, Demedts MG, Geusens P. Safety and efficacy of fluticasone and beclomethasone in moderate to severe asthma. Am J Respir Crit Care Med 1998; 157: 827 32.
19. Simon RA. Update on inhaled corticosteroids. Allergy Asthma Proc 1999; 20: 161 5.
20. Kelly HW. Comparison of inhaled corticosteroids. Ann Pharmacother 1998; 32: 220 32.
21. Weitzman ED, Fukushima D, Nogeire C, et al. Twenty four hour pattern of the episodic secretion of Cortisol in normal subjects. J Clin Bndocrinol 1971; 33: 14 22.
22. Nicolaizik WH, Marchant JL, Preece MA, warner JO. Endocrine and lung function in asthmatic children on inhaled corticosteroids. Am J Respir Crit Care Med 1994; 150: 624 8.
23. Grahnen A, Eckernas SA, Brundin RM, Ling Andersson A. An assessment of the systemic activity of single doses of inhaled fluticasone propionate in healthy volunteers. BR J Clin Pharmacol 1994; 38: 521 5.
24. Ebden P, Jenkins A, Houston G, Davies BH. Comparison of two high dose corticosteroid aerosol treatments, beclomethasone dipropionate (1500 meg/day) and budesonide (1600mcg/day), for chronic asthma. Thorax 1986; 41: 869 74.

Thank you for copying data from http://www.arastirmax.com