Comparison of the Efficacy of Inhaled Fluticasone Propionate with Triamcinolone Acetonide in Children with Moderate Persistent Asthma

Abstract

Inhaled corticosteroids are the most effective therapy available today for children and adults with chronic asthma. There have been relatively few studies comparing inhaled steroids in children. In a 2-year crossover study, we compared the efficacy of inhaled fluticasone propionate (FP), 880 μg/d (2 puffs of 220 μg per puff) administered twice daily, with that of triamcinolone acetonide (TA), 900 μg/d (3 puffs of 100 μg per puff administered 3 times a day). Nine children with moderate persistent asthma, with a mean age of 13 years (range, 10–18 years) and a mean duration of asthma of 8 years, initially received TA, 900 μg/d, for 1 year and then were switched to FP, 880 μg/d, and followed for an additional year. Pulmonary function tests (PFTs) were monitored and analyzed before and after the switch for the duration of the study. Mean percentages of those predicted for age values for forced expiratory volume in 1 second (FEV₁), forced expiratory flow between 25 and 75% of vital capacity (FEF_25-75%), and peak expiratory flow rate (PEFR) were compared at 1-month, 2 to 6-month, and 7 to 12-month intervals. The number of asthma exacerbations, emergency room visits, hospital admissions, and school days lost were also compared. There was significant improvement in mean asthma exacerbations per patient per year while patients were receiving FP (4.88 ± 2.93 SD vs. 2.33 ± 2.06 SD; p < 0.05). There was a trend towards improvement in the number of emergency room visits, hospital admissions, and school days lost while patients were on FP, but the difference was not significant. A significant improvement in mean percentage of those predicted for age values for FEV₁ was noted while patients were receiving FP (p < 0.05 for all three periods). The mean percentage of that predicted for age values for FEF_25-75% significantly improved at 1 month after the switch, but there were no significant differences during the 2 to 6-month and 7 to 12-month periods. FP, 880 μg/d, improved lung function and decreased the number of asthma exacerbations in adolescents with moderate persistent asthma when compared with a similar dosage of TA.