Randomised controlled trial of inhaled corticosteroids (fluticasone propionate) in cystic fibrosis.

Abstract:

BACKGROUND:Controlling lung inflammation may be the key to improving morbidity and mortality in cystic fibrosis. OBJECTIVE:To assess the effects of inhaled corticosteroids on lung inflammation in cystic fibrosis. DESIGN:Double blind placebo controlled randomised sequence crossover trial. Fluticasone propionate (400 micrograms/day) was given as a dry powder inhaler for six weeks with a four week washout period before crossover. OUTCOME MEASURES:Sputum inflammatory markers (interleukin-8, tumour necrosis factor-alpha (TNF-alpha) and neutrophil elastase-both free and bound to alpha 1-antiprotease), sputum interleukin-10, lung function, and symptomatology. SUBJECTS:Twenty three children from a regional cystic fibrosis centre were enrolled into the study, with mean age 10.3 years (range 7 to 17 years) and mean baseline forced expiratory volume in one second (FEV1) of 64% (range 21% to 102%) predicted for sex and height. One patient was excluded for non-compliance to the study protocol. RESULTS:No significant benefit was shown for the use of fluticasone propionate in any of the outcomes. For sputum interleukin-8 there was an estimated true treatment median difference of 142 pg/ml (95% confidence interval (CI) 8 to 2866 pg/ml) in favour of placebo; while for maximal expiratory flow at 25% (MEF25%) remaining forced vital capacity predicted for sex and height there was a 15 percentage points (pp) (95% CI 4 to 26 pp) mean treatment difference in favour of placebo. Sputum interleukin-10 was undetected in any samples and unaffected by fluticasone propionate. Neither atopic status, baseline FEV1, nor concomitant DNase therapy had any effect on response to treatment. CONCLUSIONS:Lack of benefit from fluticasone propionate was most likely due to failure of the drug to penetrate the viscid mucus lining the airways. It is suggested a large multicentre trial with higher doses given for a longer time by a different delivery system is required to assess efficacy.

journal_name

Arch Dis Child

authors

Balfour-Lynn IM,Klein NJ,Dinwiddie R

doi

10.1136/adc.77.2.124

subject

Has Abstract

pub_date

1997-08-01 00:00:00

pages

124-30

issue

2

eissn

0003-9888

issn

1468-2044

journal_volume

77

pub_type

临床试验,杂志文章,随机对照试验
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    doi:10.1136/adc.67.1_spec_no.63

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    更新日期:1992-01-01 00:00:00

  • Hypertension associated with increased renin concentrations in nephroblastoma.

    abstract::An infant with severe hypertension who had a nephroblastoma which was secreting active renin is described. Nephroblastoma must be included in the differential diagnosis of hypertension associated with increased renin concentrations, even in the absence of an abdominal mass. ...

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    doi:10.1136/adc.66.4.525

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    doi:10.1136/adc.86.6.436

    authors: Yao TC,Hung IJ,Jaing TH,Yang CP

    更新日期:2002-06-01 00:00:00

  • Children travelling for treatment: what we don't know.

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    journal_title:Archives of disease in childhood

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    doi:10.1136/adc.69.1.104

    authors: Cross JH,Jackson GD,Neville BG,Connelly A,Kirkham FJ,Boyd SG,Pitt MC,Gadian DG

    更新日期:1993-07-01 00:00:00

  • Hiccups and breathing in human fetuses.

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章,评审

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    更新日期:2011-04-01 00:00:00

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    doi:10.1136/adc.53.1.58

    authors: Smales OR,Kime R

    更新日期:1978-01-01 00:00:00

  • Neonatal tuberculosis.

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章,随机对照试验

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  • Continuing need for mineralocorticoid therapy in salt-losing congenital adrenal hyperplasia.

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    journal_title:Archives of disease in childhood

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    journal_title:Archives of disease in childhood

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章

    doi:10.1136/adc.2007.129239

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  • Phototherapy for neonatal hyperbilirubinaemia: the importance of dose.

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    pub_type: 杂志文章

    doi:10.1136/adc.58.6.406

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    pub_type: 杂志文章

    doi:10.1136/adc.71.2.119

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  • Hypothalamo-pituitary hormone insufficiency associated with cleft lip and palate.

    abstract::Two male patients with congenital cleft lip and palate first seen at ages 10.2 and 21.5 years presented with typical signs of hypothalamic-interior pituitary hormone deficiencies. They were found to lack GH, LH, and FSH and to be partially deficient in TSH and ACTH. Several congenital defects may explain this rare syn...

    journal_title:Archives of disease in childhood

    pub_type: 杂志文章

    doi:10.1136/adc.53.12.952

    authors: Roitman A,Laron Z

    更新日期:1978-12-01 00:00:00

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    pub_type: 杂志文章

    doi:10.1136/adc.50.11.879

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    更新日期:1975-11-01 00:00:00

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章

    doi:10.1136/adc.60.1.56

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    更新日期:1985-01-01 00:00:00

  • Bile acid excretion after pull-through operation for Hirschsprung's disease.

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    journal_title:Archives of disease in childhood

    pub_type: 杂志文章

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  • Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study.

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    pub_type: 杂志文章,多中心研究,随机对照试验

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