Effects of Mometasone Furoate Dry Powder Inhaler and Beclomethasone Dipropionate Hydrofluoroalkane and Chlorofluorocarbon: Discussion
This study compared the effect of MF-DPI on the HPA axis with that of another commonly used ICS, BDP, in subjects with asthma. The results demonstrate that a similar magnitude of HPA-axis suppression occurred with BDP via HFA and CFC MDI, despite the differences in BDP doses: 200 ^g bid vs 400 ^g bid. This confirms previous findings by Jackson and Lipworth- indicating greater systemic bioavailability and enhanced cortisol suppression with the HFA formulation of BDP vs the CFC formulation. The median percentage reduction in the serum cortisol concentrations AUC0-24 of 23 to 24% with BDP was significantly greater than the 9% reduction seen with MF-DPI treatment. This low magnitude of cortisol secretory suppression seen with MF-DPI is in keeping with a previous 28-day study in subjects with mild-to-moderate asthma. In that study, MF-DPI at doses from 200 ^g bid to 1,200 ^g qd had no impact on dynamic cortisol secretion in response to low-dose cosyntropin, while the mean serum cortisol concentrations AUC0-24h was in the range of 82 to 107% of placebo.
The minor effect of MF-DPI treatment on serum cortisol concentrations AUC0-24h compared with BDP in the current study was reflected in the results of the 24-h UFC excretion. The mean decrease in 24-h UFC excretion of 9.6% ( — 8.2 nmol/L/24 h) with MF-DPI was lower than the decreases seen with HFA-BDP (34.3%; — 27.9 nmol/L/24 h; p = 0.047) and CFC-BDP (33.4%; — 18.0 nmol/ L/24 h; p = 0.073). The difference between the MF-DPI and BDP groups was maintained in the subpopulation with validated full 24-h urine samples (MF-DPI, — 9.6% [— 5.9 nmol/L/24 h]; HFA-BDP, — 43.1% [— 34.8 nmol/L/24 h]; and CFC-BDP, — 30.0% [— 19.1 nmol/L/24 h]). Subjects in the MF-DPI group had greater improvements from baseline in PEF measured morning (35 L/min) and evening (41 L/min), compared with BDP (morning, 20 to 21 L/min; evening, 17 L/min; p = not significant).
Roles of Angiopoietin-1 and Angiopoietin-2 on Airway Microvascular Permeability in Asthmatic Patients: Methods and Materials
Thirty patients with asthma and 12 age-matched control subjects were included in the study. All control subjects were healthy, nonsmoking volunteers who had no history of lung disease. All patients with asthma were recruited from respiratory outpatient clinics at our institution; they were nonsmokers and satisfied American Thoracic Society criteria for asthma. Methacholine inhalation challenge testing was performed for all study subjects as we previously described. All subjects with asthma in this study demonstrated bronchial hyperreactivity to methacholine. Exhaled nitric oxide (NO) was measured for all subjects with a chemiluminescence analyzer (CLM-500; Shimazu; Kyoto, Japan) in accordance with American Thoracic Society standards. The mean value of three expiratory NO concentrations was calculated for each subject and expressed as parts per billion. At study entry, regular medication in asthmatic patients consisted of short-acting p2-agonists on demand. No patients were receiving oral or inhaled corticosteroids. All patients with asthma were clinically stable, and none had a history of respiratory infection for at least the 4-week period preceding the study. All subjects gave their written informed consent for participation in the study, which was approved by the ethics committee of Osaka City University.