Effect of prolonged use of inhaled steroids on the cellular immunity of children with asthma,☆☆,

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Abstract

Background: Systemic corticosteroids may affect the cellular immunity, but there is no available controlled data on such effects associated with a prolonged use of inhaled corticosteroids. Objective: The investigation was designed to study the effect of long-term inhaled beclomethasone dipropionate in daily doses of up to 600 μg on cellular immune functions. Methods: Twenty-four children with asthma treated with inhaled beclomethasone dipropionate for a mean of 22.6 months were compared with 16 children with asthma not treated with an inhaled steroid and with 20 healthy adults. Cellular immune parameters included differential white blood count, T- and B-cell numbers, T helper and suppressor counts, T-cell mitogenic transformation, and interleukin-1 and interleukin-2 secretion. Results: There was no difference in any of the studied cellular immune functions among the three study groups. Conclusion: Long-term use of inhaled beclomethasone dipropionate by children with asthma, at daily doses of up to 600 μg, has no effect on certain parameters of cellular immunity. (J ALLERGY CLIN IMMUNOL 1995;95:806-12.)

Section snippets

Patients

Parameters of cellular immunity were studied in 40 asthmatic children from the Pediatric Pulmonary Clinics of Soroka Medical Center in Beer Sheva.

A group of 24 children (21 boys and 3 girls) with asthma, aged 3 to 18.5 years (mean age, 8.8 years) constituted the BDP group. Twenty-two of them were atopic as determined by positive skin test results. They were treated twice daily with inhaled BDP (Becotide-Glaxo) 200 to 600 μg/day (mean, 382 μg/day or 16.5 μg/kg/day) for a mean of 22.6 months

RESULTS

Sixty individuals (40 children with asthma and 20 healthy control subjects) were included in the study. Asthmatic children treated with BDP were compared with asthmatic children not treated with BDP. Fig. 1 shows that there were no significant differences in the differential WBC count regarding lymphocytes, neutrophils, and eosinophils ( p = 0.83). Mean total WBC count was 7595 in the BDP-treated group and 6972 in the non-BDP-treated group (7200 in normal control subjects). Polymorphonuclear

DISCUSSION

Chronic inflammation appears to be a major component in the pathogenesis of asthma. The inflammation of the respiratory epithelium results in swelling of mucous membranes, increased secretion of viscous mucus, and enhanced plugging of the medium- and small-sized airways. 19 The corticosteroids, which exhibit strong antiinflammatory effects, can reduce these processes and thus be of great use for patients with asthma. However, in addition to the antiinflammatory effect, systemically administered

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    From the Departments of aPediatrics, bClinical Immunology Laboratory, cImmunology and Microbiology, and dEpidemiology, Soroka Medical Center of Kupat Holim and The Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel; and e Department of Statistics, Colorado State University, Denver.

    ☆☆

    Reprint requests: Jacov Levy, MD, Department of Pediatrics, Soroka Medical Center, P.O. Box 151, Beer Sheva, Israel, 84101.

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