Postallergen inhaled budesonide reduces late asthmatic response and inhibits the associated increase of airway responsiveness to methacholine in asthmatics.

Abstract

To determine whether inhaled budesonide given after allergen inhalation challenge inhibits the late asthmatic response (LAR) and/or the associated increase of airway responsiveness to methacholine, we performed a double-blind randomized cross-over study in 12 adult asthmatics (eight male, four female; mean age, 20.3 yr; range, 18 to 29 yr) sensitized to Dermatophagoides pteronyssinus (DP) previously shown to develop early and late asthmatic response to allergen challenge with DP. On different days each subject was randomized to receive budesonide 800 micrograms by Turbuhaler or placebo, given three times; (1) after allergen inhalation, after the onset of LAR, when FEV1 had fallen by > or = 15%; (2) 2 h later; (3) 4 h later. Airway responsiveness to methacholine was measured before allergen challenge at 8 to 10 h from allergen inhalation and 24 h after the allergen inhalation. Inhaled budesonide significantly reduced the LAR induced by allergen (maximal % fall in FEV1, delta FEV1%: -23 +/- 6% with budesonide versus -38 +/- 9% with placebo; p < 0.001) and inhibited the associated increase of airway responsiveness (geometric mean of PD20FEV1 methacholine: 0.047 mg after budesonide versus 0.033 mg after placebo at 8 to 10 h, p < 0.05; 0.119 mg after budesonide versus 0.062 mg after placebo at 24 h, p < 0.01). These results suggest that inhaled budesonide may not only prevent but also reduce the late asthmatic response induced by allergen and that it might also be considered in the treatment of exacerbation of asthma.

Inhalation challenges with agents causing occupational asthma

“…Dosedependent inhibition of LAR induced by LMW agents has also been documented after prolonged treatment with inhaled and oral steroids [144,[169][170][171]. When administered after EAR, inhaled steroids are effective in reducing the LAR [154,155], but are only slightly effective in inhibiting the increase in NSBHR [154,155]. This is consistent with the observation that an increase in NSBHR can develop as soon as 1-3 h after the early component of DAR.…”

Differences in the efficacy and safety among inhaled corticosteroids (ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD): Role of ICS

“…On the other hand, the more balanced lipophilic/hydrophilic characteristics of budesonide may explain its higher efficacy in terms of rapid onset of action, in part due to the strong nongenomic effects of budesonide. Several in vitro and in vivo experimental studies have confirmed that an anti-inflammatory effect of budesonide may be detected a few hours after administration [11,12].…”

Montelukast as add-on therapy to β-agonists and late airway response

“…Studies on an effect of fluticasone or budesonide compared with montelukast revealed a positive impact of all three substances on an early asthmatic response, with steroids being superior in improving bronchial hyperresponsiveness [26,27]. Additionally, a positive impact of inhaled corticosteroids on the late asthmatic response could also be demonstrated [28]. Keeping the side-effects of steroids in mind, the goal of the present study was to further investigate montelukast as an add-on option to b-mimetics in mild bronchial asthma.…”