Comparative effects of hydrofluoroalkane and chlorofluorocarbon beclomethasone dipropionate inhalation on small airways: Assessment with functional helical thin-section computed tomography

A double-blind, randomized, parallel-group pilot study compared the relative efficacy of hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP [QVAR]; mass median aerodynamic diameter, 0.8-1.2 m) versus cholorofluorocarbon-11/12 BDP (CFC-BDP [Beclovent]; mass median aerodynamic diameter, 3.5-4...

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Bibliographic Details
Published in:	Journal of allergy and clinical immunology Vol. 104; no. 6; pp. s258 - s267
Main Authors:	Goldin, Jonathan G., Tashkin, Donald P., Kleerup, Eric C., Greaser, Lloyd E., Haywood, Ulrika M., Sayre, James W., Simmons b, Michael D., Suttorp, Marika, Colice, Gene L, Vanden Burgt, Jennifer A., Aberle, Denise R.
Format:	Journal Article
Language:	English
Published:	United States Mosby, Inc 01-12-1999
Subjects:	Administration, Inhalation Adult Aerosol Propellants - administration & dosage Aerosol Propellants - pharmacology asthma Asthma - drug therapy Beclomethasone - administration & dosage Beclomethasone - pharmacology beclomethasone diproprionate Bronchial Provocation Tests chlorofluorocarbon Chlorofluorocarbons - administration & dosage Chlorofluorocarbons - pharmacology Double-Blind Method Female Humans Hydrocarbons, Fluorinated - administration & dosage Hydrocarbons, Fluorinated - pharmacology Hydrofluoroalkane Image Processing, Computer-Assisted Lung - drug effects Male Middle Aged Peak Expiratory Flow Rate Pilot Projects Respiratory Function Tests small airways Spirometry thin-section computed tomography Tomography Scanners, X-Ray Computed Hydrofluoroalkane RV beclomethasone diproprionate MMAD asthma FOV chlorofluorocarbon thin-section computed tomography LAC FRC HFA-BDP HRCT small airways CFC-BDP
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Summary:	A double-blind, randomized, parallel-group pilot study compared the relative efficacy of hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP [QVAR]; mass median aerodynamic diameter, 0.8-1.2 m) versus cholorofluorocarbon-11/12 BDP (CFC-BDP [Beclovent]; mass median aerodynamic diameter, 3.5-4.0 m) in 31 steroid naive patients with mild to moderate asthma (PC 20, 4 mg/mL). Functional high-resolution computed tomography was used to assess the relative efficacy of HFA-BDP and CFC-BDP on regional air trapping, as an indirect measure of small airways function and on regional hyperreactivity. Pretreatment functional computed tomography was performed at residual volume before and after methacholine challenge. After 4 weeks of treatment, functional imaging was repeated before and after the same concentration of methacholine that was administered before the treatment (n = 19 patients). Quantitative assessment of changes in distribution of lung attenuation was performed. After 4 weeks of treatment, the HFA-BDP group showed significantly more improvement in air trapping overall (a shift in the lung attenuation curve at residual volume toward more attenuation) on the posttreatment computed tomography scan ( P < .05; Fisher’s Exact Test). After an equal constrictor stimulus (methacholine concentration), subjects treated with HFA-BDP (n = 10 patients) showed less increase in air trapping overall than subjects treated with CFC-BDP (n = 9 patients) on the posttreatment scans compared with the pretreatment scans ( P < .001; Fisher’s Exact Test). No significant difference was demonstrated between the 2 treatment groups with respect to improvement in symptoms, spirometry, or methacholine responsiveness assessed by FEV 1, except for a greater reduction in breathlessness in the HFA-BDP group ( P < .05). We conclude that HFA-BDP may have greater efficacy in the peripheral airways and that this effect is better assessed with functional imaging computed tomography techniques than with conventional physiologic tests. (J Allergy Clin Immunol 1999;104:S258-67.)
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0091-6749 1097-6825
DOI:	10.1016/S0091-6749(99)70043-6