Background Evidence suggests that systemic inflammation may play an important role in the progression and morbidity of chronic obstructive pulmonary disease. It remains controversial whether inhaled corticosteroid in ...Background Evidence suggests that systemic inflammation may play an important role in the progression and morbidity of chronic obstructive pulmonary disease. It remains controversial whether inhaled corticosteroid in combination with a long-acting 132-adrenoceptor agonist can attenuate systemic inflammation. We evaluated the effect of salmeterol/fluticasone propionate on circulating C-reactive protein level in stable chronic obstructive pulmonary disease patients. Methods An open-label clinical trial was conducted to recruit 122 outpatients with stable moderate-to-severe chronic obstructive pulmonary disease from department of respiratory medicine in two teaching hospitals between June 2007 and March 2008. Patients were randomized into two groups （1：1） to receive either the combination of 50 μg salmeterol and 500 μg fluticasone twice daily （n=61）, or the combination of 206 μg albuterol and 36 pg ipratropium q.i.d （n=61） over 6 months. Circulating C-reactive protein concentrations were measured before randomization and during the follow-up. The efficacy of treatment was also assessed by spirometry, as well as health status and dyspnea score at baseline and after 6-month treatment. Results Baseline characteristics of two groups were similar. Compared with ipratropium/albuterol, the combination of salmeterol/fluticasone significantly reduced circulating level of C-reactive protein （-1.73 vs. 0.08 mg/L, respectively, P 〈0.05） after 6-month treatment. Forced expiratory volume in one second （FEV1） and health status also improved significantly in salmeterol/fluticasone group compared with ipratropium/albuterol. Salmeterol/fluticasone treatment subjects who had a decrease of circulating C-reactive protein level had a significant improvement in FEV1 and St George＇s Respiratory Questionnaire total scores compared with those who did not （185 vs. 83 ml and -5.71 vs. -1.79 units, respectively, both P 〈0.01）. Conclusion Salmeterol/fluticasone treatment reduced circulating C-reactive protein concentration in clinically stable moderate-to-severe chronic obstructive pulmonary disease patients after 6-month treatment.展开更多
Background:Despite the recommendation of inhaled corticosteroids(ICSs)plus long-acting beta 2-agonist(LABA)and leukotriene receptor antagonist(LTRA)or ICS/LTRA as stepwise approaches in asthmatic children,there is a l...Background:Despite the recommendation of inhaled corticosteroids(ICSs)plus long-acting beta 2-agonist(LABA)and leukotriene receptor antagonist(LTRA)or ICS/LTRA as stepwise approaches in asthmatic children,there is a lack of published systematic review comparing the efficacy and safety of the two therapies in children and adolescents aged 4 to 18 years.This study aimed to compare the safety and efficacy of salmeterol/fluticasone(SFC)vs.montelukast(MON),or combination of montelukast and fluticasone(MFC)in children and adolescents aged 4 to 18 years with bronchial asthma.Methods:A systematic search was conducted in MEDLINE,EMBASE,the Cochrane Library,China BioMedical Literature Database,Chinese National Knowledge Infrastructure,VIP Database for Chinese Technical Periodical,and Wanfang for randomized controlled trials(RCTs)published from inception to May 24,2021.Interventions are as follows:SFC vs.MON,or combination of MFC,with no limitation of dosage or duration.Primary and secondary outcome measures were as follows:the primary outcome of interest was the risk of asthma exacerbation.Secondary outcomes included risk of hospitalization,pulmonary function,asthma control level,quality of life,and adverse events(AEs).A random-effects(I^(2)≥50%)or fixed-effects model(I^(2)<50%)was used to calculate pooled effect estimates,comparing the outcomes between the intervention and control groups where feasible.Results:Of the 1006 articles identified,21 studies met the inclusion criteria with 2643 individuals;two were at low risk of bias.As no primary outcomes were similar after an identical treatment duration in the included studies,meta-analysis could not be performed.However,more studies favored SFC,instead of MON,owing to a lower risk of asthma exacerbation in the SFC group.As for secondary outcome,SFC showed a significant improvement of peak expiratory flow(PEF)%pred after 4 weeks compared with MFC(mean difference[MD]:5.45;95%confidence interval[CI]:1.57-9.34;I^(2)=95%;P=0.006).As for asthma control level,SFC also showed a higher full-controlled level(risk ratio[RR]:1.51;95%CI:1.24-1.85;I^(2)=0;P<0.001)and higher childhood asthma control test score after 4 weeks of treatment(MD:2.30;95%CI:1.39-3.21;I^(2)=72%;P<0.001)compared with MFC.Conclusions:SFC may be more effective than MFC for the treatment of asthma in children and adolescents,especially in improving asthma control level.However,there is insufficient evidence to make firm conclusive statements on the use of SFC or MON in children and adolescents aged 4 to 18 years with asthma.Further research is needed,particularly a combination of good-quality long-term prospective studies and well-designed RCTs.PROSPERO registration number:CRD42019133156.展开更多
The apparent degradation rate constant of fluticasone propionate(FLT) in 0.1 M NaOH:methanol=1:1 at 37 °C was previously reported to be 0.169 ± 0.003 h^(-1), and four degradation products(products 1–4) were...The apparent degradation rate constant of fluticasone propionate(FLT) in 0.1 M NaOH:methanol=1:1 at 37 °C was previously reported to be 0.169 ± 0.003 h^(-1), and four degradation products(products 1–4) were observed in the solution. The aims of the present study were to assess the degradation rates of FLT in other alkaline solutions and clarify the chemical structures of the four degradation products in order to obtain basic data for designing an enema for inflammatory bowel disease. The apparent degradation rate constants in 0.05 M NaOH and 0.1 M NaOH:CH_3CN=1:1 were 0.472 ± 0.013 h^(-1) and 0.154 ± 0.000 h^(-1)(n=3), respectively. The chemical structures of products 1–4 in 0.1 M NaOH:methanol=1:1 were revealed by nuclear magnetic resonance(NMR)and mass spectrometry data. The chemical structure of products 2 was that the 17-position of the thioester moiety of FLT was substituted by a carboxylic acid. The degradation product in 0.1 M NaOH:CH_3CN=1:1 was found to be product 2 based on ~1H NMR data. The degradation product in 0.05 M NaOH was considered to be product 2 based on the retention time of HPLC. These results are useful for detecting the degradation products of FLT by enzymes of the intestinal bacterial flora in the large intestine after dosing FLT as an enema.展开更多
Lichen planus is a fairly common chronic idiopathic disorder of the skin,nails and mucosal surfaces.Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in litera...Lichen planus is a fairly common chronic idiopathic disorder of the skin,nails and mucosal surfaces.Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature.Given its rarity,it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis.Currently,there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach.Systemic steroids are usually the first line treatment and offer a favorable response.In this report,we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk,as evidenced by objective clinical findings.Based on our review of related literature and experience in this patient,we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment.展开更多
文摘Background Evidence suggests that systemic inflammation may play an important role in the progression and morbidity of chronic obstructive pulmonary disease. It remains controversial whether inhaled corticosteroid in combination with a long-acting 132-adrenoceptor agonist can attenuate systemic inflammation. We evaluated the effect of salmeterol/fluticasone propionate on circulating C-reactive protein level in stable chronic obstructive pulmonary disease patients. Methods An open-label clinical trial was conducted to recruit 122 outpatients with stable moderate-to-severe chronic obstructive pulmonary disease from department of respiratory medicine in two teaching hospitals between June 2007 and March 2008. Patients were randomized into two groups （1：1） to receive either the combination of 50 μg salmeterol and 500 μg fluticasone twice daily （n=61）, or the combination of 206 μg albuterol and 36 pg ipratropium q.i.d （n=61） over 6 months. Circulating C-reactive protein concentrations were measured before randomization and during the follow-up. The efficacy of treatment was also assessed by spirometry, as well as health status and dyspnea score at baseline and after 6-month treatment. Results Baseline characteristics of two groups were similar. Compared with ipratropium/albuterol, the combination of salmeterol/fluticasone significantly reduced circulating level of C-reactive protein （-1.73 vs. 0.08 mg/L, respectively, P 〈0.05） after 6-month treatment. Forced expiratory volume in one second （FEV1） and health status also improved significantly in salmeterol/fluticasone group compared with ipratropium/albuterol. Salmeterol/fluticasone treatment subjects who had a decrease of circulating C-reactive protein level had a significant improvement in FEV1 and St George＇s Respiratory Questionnaire total scores compared with those who did not （185 vs. 83 ml and -5.71 vs. -1.79 units, respectively, both P 〈0.01）. Conclusion Salmeterol/fluticasone treatment reduced circulating C-reactive protein concentration in clinically stable moderate-to-severe chronic obstructive pulmonary disease patients after 6-month treatment.
文摘Background:Despite the recommendation of inhaled corticosteroids(ICSs)plus long-acting beta 2-agonist(LABA)and leukotriene receptor antagonist(LTRA)or ICS/LTRA as stepwise approaches in asthmatic children,there is a lack of published systematic review comparing the efficacy and safety of the two therapies in children and adolescents aged 4 to 18 years.This study aimed to compare the safety and efficacy of salmeterol/fluticasone(SFC)vs.montelukast(MON),or combination of montelukast and fluticasone(MFC)in children and adolescents aged 4 to 18 years with bronchial asthma.Methods:A systematic search was conducted in MEDLINE,EMBASE,the Cochrane Library,China BioMedical Literature Database,Chinese National Knowledge Infrastructure,VIP Database for Chinese Technical Periodical,and Wanfang for randomized controlled trials(RCTs)published from inception to May 24,2021.Interventions are as follows:SFC vs.MON,or combination of MFC,with no limitation of dosage or duration.Primary and secondary outcome measures were as follows:the primary outcome of interest was the risk of asthma exacerbation.Secondary outcomes included risk of hospitalization,pulmonary function,asthma control level,quality of life,and adverse events(AEs).A random-effects(I^(2)≥50%)or fixed-effects model(I^(2)<50%)was used to calculate pooled effect estimates,comparing the outcomes between the intervention and control groups where feasible.Results:Of the 1006 articles identified,21 studies met the inclusion criteria with 2643 individuals;two were at low risk of bias.As no primary outcomes were similar after an identical treatment duration in the included studies,meta-analysis could not be performed.However,more studies favored SFC,instead of MON,owing to a lower risk of asthma exacerbation in the SFC group.As for secondary outcome,SFC showed a significant improvement of peak expiratory flow(PEF)%pred after 4 weeks compared with MFC(mean difference[MD]:5.45;95%confidence interval[CI]:1.57-9.34;I^(2)=95%;P=0.006).As for asthma control level,SFC also showed a higher full-controlled level(risk ratio[RR]:1.51;95%CI:1.24-1.85;I^(2)=0;P<0.001)and higher childhood asthma control test score after 4 weeks of treatment(MD:2.30;95%CI:1.39-3.21;I^(2)=72%;P<0.001)compared with MFC.Conclusions:SFC may be more effective than MFC for the treatment of asthma in children and adolescents,especially in improving asthma control level.However,there is insufficient evidence to make firm conclusive statements on the use of SFC or MON in children and adolescents aged 4 to 18 years with asthma.Further research is needed,particularly a combination of good-quality long-term prospective studies and well-designed RCTs.PROSPERO registration number:CRD42019133156.
文摘The apparent degradation rate constant of fluticasone propionate(FLT) in 0.1 M NaOH:methanol=1:1 at 37 °C was previously reported to be 0.169 ± 0.003 h^(-1), and four degradation products(products 1–4) were observed in the solution. The aims of the present study were to assess the degradation rates of FLT in other alkaline solutions and clarify the chemical structures of the four degradation products in order to obtain basic data for designing an enema for inflammatory bowel disease. The apparent degradation rate constants in 0.05 M NaOH and 0.1 M NaOH:CH_3CN=1:1 were 0.472 ± 0.013 h^(-1) and 0.154 ± 0.000 h^(-1)(n=3), respectively. The chemical structures of products 1–4 in 0.1 M NaOH:methanol=1:1 were revealed by nuclear magnetic resonance(NMR)and mass spectrometry data. The chemical structure of products 2 was that the 17-position of the thioester moiety of FLT was substituted by a carboxylic acid. The degradation product in 0.1 M NaOH:CH_3CN=1:1 was found to be product 2 based on ~1H NMR data. The degradation product in 0.05 M NaOH was considered to be product 2 based on the retention time of HPLC. These results are useful for detecting the degradation products of FLT by enzymes of the intestinal bacterial flora in the large intestine after dosing FLT as an enema.
文摘Lichen planus is a fairly common chronic idiopathic disorder of the skin,nails and mucosal surfaces.Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature.Given its rarity,it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis.Currently,there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach.Systemic steroids are usually the first line treatment and offer a favorable response.In this report,we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk,as evidenced by objective clinical findings.Based on our review of related literature and experience in this patient,we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment.
