A COMPARATIVE STUDY ON THE ANTI-INFLAMMATORY EFFECT OF BECLOMETHASONE, SALMETEROL AND THEOPHYLLINE IN ASTHMATIC CHILDREN.

Airway inflammation plays an important role in the pathogenesis of asthma, making it an important target for anti-asthma pharmacotherapy. The aim of this study was to evaluate the antiinflammatory effect of beclomethasone, salmeterol and theophylline in children suffering from asthma. This study was carried out at the Chest and Allergy Unit, Pediatric Department, Tanta University Hospital, from October 2001 to January 2004. This work comprised ninety asthmatic children (aged 6-13 yrs), who were classified into two groups according to their pulmonary function that measured as percentage of the predicted forced expiratory volume in 1 second (FEV1%). Group 1: included 30 children with mild asthma and their FEV1% was 70-80%, and Group 2: included 60 children with moderate to severe asthma and their FEV1% less than 70% of the predicted value. Each group was subdivided into three subgroups to receive one of the following drug modalities; inhaled beclomethasone dipropionate, oral sustained-release theophylline or inhaled long acting p-2 agonist (Salmeterol) for consecutive 8 weeks. The systemic levels of some inflammatory markers such as absolute eosinophilic count (AEC), eosinophilic cationic protein (ECP), leukotriene B4 (LTB4) and tumor necrosis factor-a (TNF-a) were measured at the time of representation and at the end of the study. Treatment with beclomethasone significantly decreased AEC, ECP, LTB-4 and TNF-alpha with concomitant significant increase in FEV1%. Theophylline also significantly decreased the measured inflammatory indices, but to lesser extent than beclomethasone. Salmeterol decreased serum levels of TNF-alpha and ECP in asthmatic children but in non significant manner. As conclusion inhaled corticosteroids exhibit high antiinflammatory effect than theophylline and Beta-2 agonist, and considered as good controller to bronchial asthma. These findings suggest that monitoring airway inflammation may predict success orfailure of reduction of inhaled steroids and may be useful in optimizing the treatment of children with asthma. Theophylline or salmeterol may be used as add on therapy for children treated with corticosteroids.