Volume 4 Supplement 1
P83 - Asthma inflammatory subtype specific treatment; a randomised clinical study
© Youssef et al; licensee BioMed Central Ltd. 2014
Published: 28 February 2014
Macrolides antibiotics, such as clarithromycine express immunomodulatory and tissue reparative effects that are distinct from their anti-infective properties, and have in vitro efficacy against neutrophils.
Aim of study
To determine the efficacy of add-on therapies that target eosinophilic and noneosinophilic airway inflammation and their effects on asthma control test, pulmonary function and asthma symptoms.
single blind randomized clinical trial; asthmatic children with persistent symptoms undergoing treatment with fluticasone 100 mg bid and β2 agonist as required were studied. Group A (23 males / 17 females, aged 11.5±1.8 years) received fluticasone 200mg bid, and group B (21 males / 19 females, aged 11.5±1.8 years) clarithromycine 15 mg/kg bid, in addition to fluticasone 100 mg bid for 8 weeks. (FEV1%, C-CAT, SABA use, sputum induced % of eosinophils and neutrophils) were compared before and after treatment in each group.
In group A there is significant reduction of eosinophils percentage after treatment, and non significant increase in neutrophils percentage. There was significant improvement in FEV1% predicted. While in group B there was non significant decrease in eosinophils, and significant decrease in neutrophils. In group A there was significant negative correlation between changes in FEV1% and change in eosinophils and week positive correlation between changes in FEV1% and changes in neutrophils. In group B there was significant positive correlation between basal eosinophils and change in FEV1% and significant negative correlation between basal neutrophils and change in FEV1%.
Steroids were effective in targeting eosinophilic inflammation and clarithromycine target neutrophilic inflammation. High eosinophils and neutrophils percentage in sputum are best predictors of response to steroids or clarithromycine treatment respectively.
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