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CFC-BDP (n?=?119), whereas conventional clinical indexes of lung function and asthma control were similar in the two treatment groups. In a small, single-blind, randomised study of patients with poorly controlled asthma (mean FEV1 at inclusion <60% of predicted value), in spite of treatment with moderate-to-high-dose-inhaled ICS plus LABA and/or leukotriene receptor antagonist, add-on HFA-BDP had �C compared with CFC-fluticasone (CFC-FP) �C a greater effect on parameters reflecting small airway patency, including ratio of closing volume to vital capacity and FEF25-75(38). In line with this, Goldin et?al. (39) reported greater reduction in air trapping and methacholine-induced air trapping with HFA-BDP compared with CFC-BDP, but unfortunately used equivalent doses of each BDP preparation. In a more recent study, however, Tunon-de-Lara et?al. (40) did not find a treatment difference <a href="http://www.selleckchem.com/screening/anti-cancer-compound-library.html">Anticancer Compound Library chemical structure</a> in signs of air trapping between HFA-BDP and CFC-FP, as assessed by HRCT. Menzies et?al. (41) evaluated, in a double blind cross-over trial, the effects of HFA-BDP and CFC-BDP on pulmonary and systemic markers of airway inflammation in adults with mild to moderate allergic asthma. The two treatment arms consisted of: (i) 200??g CFC-BDP daily for 2 weeks, followed by 800??g CFC-BDP daily for 2 weeks, and then 800??g CFC-BDP plus <a href="https://en.wikipedia.org/wiki/Sitaxentan">Sitaxentan</a> 10?mg montelukast once daily for 1 week; and (ii) 100??g HFA-BDP daily for 2 weeks followed by 400??g HFA-BDP daily for 2 weeks, and then 400??g HFA-BDP plus 10?mg montelukast <a href="http://www.selleckchem.com/products/ch5424802.html">selleck chemicals llc</a> once daily for 1 week. Compared with baseline, treatment with low- and high-dose conventional particle CFC-BDP and extra-fine particle HFA-BDP did not lead to significant improvements in FEV1, FVC and FEF25-75. However, treatment with 100??g HFA-BDP significantly reduced serum eosinophil cationic protein (ECP) levels, whereas 200??g of CFC-BDP did not. High-dose CFC-BDP significantly reduced exhaled nitric oxide (FENO), and adding oral montelukast to this regimen did not lead to any further significant reduction. Treatment with 400??g per day of HFA-BDP also resulted in a significant reduction in FENO, and a further significant reduction was seen after the add-on of oral montelukast. In contrast to this, add-on oral montelukast had a further significant effect on peripheral eosinophils only when added to high-dose CFC-BDP, but not HFA-BDP. Taken together, these observations suggest that CFC-BDP and HFA-BDP have differential effects on pulmonary and systemic inflammation, probably reflecting the distribution of non-ultra-fine particles to more central airways and ultra-fine particles to the lung periphery. In keeping with this, Ohbayashi (42) has reported reductions in sputum ECP and eotaxin after shifting from dry powder ICS to HFA-BDP. In a retrospective matched cohort study of patients aged 5�C60 years identified through a primary care data base, Price et?al.
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