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.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.