Einfluss unterschiedlicher Dosen von Budesonid auf die exhalierte NO-Konzentration und die EPX-Konzentration im Urin bei Kindern mit Asthma bronchiale

Zusammenfassung

Das Ausmaß der bronchialen Inflammation beim Asthma bronchiale kann mit Hilfe von nichtinvasiven Methoden untersucht werden und ermöglicht das Therapieansprechen zu evaluieren. In dieser doppelblinden und randomisierten Studie wurde der Einfluss von 200 µg und 800 µg Budesonid/Tag auf die Konzentration von exhaliertem Stickstoffmonoxid (eNO), auf die Exkretion des eosinophilen Protein X (EPX) und auf Lungenfunktionsparameter bei 24 steroidnaiven Kindern und Jugendlichen mit leichtem bis mittelschwerem Asthma bronchiale über einen Zeitraum von 8 Wochen untersucht. Nach 8 Wochen nahm in beiden Gruppen die eNO-Konzentration gegenüber dem Ausgangswert signifikant ab [Median (90 % Intervall): 200 µg: - 17,2 ppb (- 54,6 bis 0,9); 800 µg: - 13,2 ppb (- 44,6 bis - 1,7); p < 0,025]. In der Hochdosisgruppe nahm die EPX-Exkretion ebenfalls gegenüber dem Ausgangswert signifikant nach 8 Wochen ab, was jedoch nicht in der Niedrigdosisgruppe der Fall war [200 µg: - 10,3 µg/mmol Kreatinin (- 116,2 bis 50,5), p = 0,9; 800 µg: - 49,2 µg/mmol Kreatinin (- 231,0 bis 48,7), p = 0,02]. Die Abnahme der eNO-Konzentration und der EPX-Exkretion nach 8 Wochen ergab zwischen beiden Therapiegruppen keinen signifikanten Unterschied (eNO: p = 0,66; EPX: p = 0,04). Zusammenfassend kann eine Tagesdosis von 800 µg Budesonid über einen Zeitraum von acht Wochen verglichen mit einer Tagesdosis von 200 µg Budesonid weder die eNO-Konzentration noch die EPX-Exkretion bei Kindern mit mildem bis mittelschwerem Asthma bronchiale stärker beeinflussen.

Abstract

The use of objective outcome measures that assess airway inflammation in pediatric asthma can provide a good evaluation of asthma severity and treatment response. In this double-blind and randomized study the effects of 200 µg of budesonide and 800 µg of budesonide on markers of inflammation (exhaled nitric oxide (eNO), eosinophil protein X (EPX) excretion in urine) and on lung function (FEV₁) were prospectively investigated in 24 ICS-naive children with mild persistent to moderate persistent asthma over a period of eight weeks. After eight weeks of treatment 200 µg and 800 µg of budesonide led to a significant decrease (p < 0.025) in eNO [median (90 % interval): 200 µg: - 17.2 ppb (- 54.6 to 0.9); 800 µg: - 13.2 ppb (- 44.6 to - 1.7)]. A significant change in urinary EPX excretion was only observed in the high dose group [200 µg: - 10.3 µg/mmol creatinine (- 116.2 to 50.5), p = 0.9; 800 µg: - 49.2 µg/mmol creatinine (- 231.0 to 48.7), p = 0.02]. However, a significant difference between the change from baseline after 8 weeks of either group was found neither for eNO (p = 0.66) nor for EPX excretion (p = 0.04). In conclusion, our data demonstrate that 800 µg budesonide per day did not show any advantage in reduction of airway inflammation, measured by eNO and urinary EPX excretion, in children with mild persistent to moderate persistent asthma.

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