Effect of ciclesonide and fluticasone on exhaled nitric oxide in patients with mild allergic asthma

Ziętkowski, Ziemowit; Bodzenta-Łukaszyk, Anna; Tomasiak, Maria Magdalena; Szymánski, W; Skiepko, Roman

doi:10.1016/j.rmed.2005.12.004

Cited by 27 publications

(11 citation statements)

References 20 publications

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“…Zietkowski et al. observed a faster and stronger decrease in exhaled NO after the treatment with HFA‐ciclesonide (80 μg or 160 μg once‐daily) compared to HFA‐FP (100 μg twice‐daily). Boulet et al.…”

Section: Treatment For Small Airway Inflammation – Clinical Implicationsmentioning

confidence: 99%

Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma

Berge

Hacken

Wiel

et al. 2012

Allergy

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Section: Treatment For Small Airway Inflammation – Clinical Implicationsmentioning

confidence: 99%

Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma

Berge

Hacken

Wiel

et al. 2012

Allergy

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“…Corticosteroids do not, however, directly inhibit STAT-6 in epithelial cells (69). Although FE NO seems a suitable biomarker for identifying and monitoring the response to ICS treatment (17,(70)(71)(72), in some asthmatics, FE NO remains increased despite optimal treatment (73,74). In allergic patients, this lack of FE NO responsiveness seems to be related to the degree of sensitisation and allergen exposure.…”

Section: Effects Of Icss and Other Asthma Controller Therapy On Exhalmentioning

confidence: 99%

Clinical aspects of using exhaled NO in asthma diagnosis and management

Lúdvı́ksdóttir

Diamant

Alving

et al. 2012

Clinical Respiratory J

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Background: Current guidelines recommend tailoring of asthma management according to disease control, which is largely defined by increased symptoms and deterioration in lung function. These features do not reflect the severity nor the type of the asthmatic airway inflammation. Fractional exhaled nitric oxide (FENO) is a simple, non-invasive and cost-effective online test applicable in both adults and children. In addition to symptoms and lung function measurements, FENO reflects airway eosinophilia and hence allows online assessment of the corticosteroidsensitive T helper 2 type airway inflammation in asthmatic patients. FENO can thus be applied to aid asthma diagnosis and treatment monitoring both in clinical practice and for research purposes. Objectives: The scope of this review is to provide an overview of the most important clinical studies using FENO in asthma management and to summarise the implications of FENO measurements in clinical practice. Results and Conclusion:In several studies, FENO measurements provided additional information on aspects of asthma including phenotyping, corticosteroidresponsiveness and disease control. Thus, if correctly applied and interpreted, FENO can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.Please cite this paper as: Ludviksdottir D, Diamant Z, Alving K, Bjermer L and Malinovschi A. Clinical aspects of using exhaled NO in asthma diagnosis and management. Clin Respir J 2012; 6: 193-207.

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“…For example, the HFA formulation of beclomethasone dipropionate (BDP) enabled effective asthma control at much lower doses than CFC-propelled BDP [9]. Ciclesonide is a novel smallparticle ICS that has shown clinical efficacy in asthma in low doses [10][11][12][13].…”

mentioning

confidence: 99%

Particle size matters: diagnostics and treatment of small airways involvement in asthma

Cohen¹,

Postma²,

Douma³

et al. 2010

Eur Respir J

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Small airways are an important site of inflammation and obstruction in asthma, which contributes to the severity of airway hyperresponsiveness (AHR) that is usually measured by nebulisation of large-particle stimuli. We investigated whether small and large particle sizes of aerosolised adenosine monophospate (AMP) provoke similar severity of AHR. Additionally, effects of the small-particle inhaled corticosteroid (ICS) ciclesonide and large-particle ICS fluticasone on AHR to large-and small-particle size AMP were assessed.After a 4-week run-in period using open-label fluticasone (100 mg b.i.d.), 37 mild-to-moderate asthmatics underwent provocations with standard-size (3.7 mm), large-particle (9.9 mm) and smallparticle (1.06 mm) AMP. Subjects received 4-week ciclesonide (160 mg s.i.d.) or fluticasone (100 mg b.i.d.) treatment (double-blind and double-dummy) followed by large-and small-particle AMP provocation.Small-particle AMP induced a 20% decrease in forced expiratory volume in 1 s (FEV1) at a significantly higher dose than large-particle AMP. Ciclesonide and fluticasone had comparable effects on AMP provocations. Not all subjects reached the provocative concentration causing a 20% fall in FEV1 (PC20) at the highest AMP dose. In those who did, ciclesonide improved smallparticle AMP PC20 by 1.74 doubling doses (DD) (p50.03), whereas fluticasone did not. Conversely, fluticasone improved large-particle AMP PC20 significantly (1.32 DD; p50.03), whereas ciclesonide did not.Small-particle AMP provocation appears to be a promising tool to assess changes in small airway inflammation. Future adjustments are necessary taking into account the very small particle size used, with large exhaled fractions. In asthmatics reaching a PC20 with small-and largeparticle AMP provocations, ciclesonide improves hyperresponsiveness to small particle size AMP, and fluticasone to large particle size. This warrants further research to target provocations and treatment to specific airway sizes.

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Effect of ciclesonide and fluticasone on exhaled nitric oxide in patients with mild allergic asthma

Cited by 27 publications

References 20 publications

Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma

Treatment of the bronchial tree from beginning to end: targeting small airway inflammation in asthma

Clinical aspects of using exhaled NO in asthma diagnosis and management

Particle size matters: diagnostics and treatment of small airways involvement in asthma

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