Comparison of the use of inhalet chromolin sodium and inhaled budesonid in seven to fourteen years old children with mild persistent and moderate persistent asthma

Comparison of the use of inhaled chromolin sodium and inhaled budesonid m seven to fourteen years old children with mild persistent and moderate persistent asthma Dr. Dilek Orbatu Bronchial asthma is a chronic inflamatuar disease characterized by recurent cough, wheezing, hyperreactivity of the airways to a variety of stimuli and a high degree of reversibility of the obstructive process, which may occur either spontaneously or as a result of treatment. Mast cells and eosinophils have key roles in the chronic inflamation of asthma. The hyperresponsiveness manifests itself as bronchoconstriction on naturel exposures to several factors, including viral infections, genetic and enviromental factors. Spesific curative threapy can be realized only when basic pathalogic mechanisms are understood. Then therapeutic modalities can be devised rationally to reverse the underlying pathagenic process. This study was carried out on 63 children who have been followed up in Department of Pediatric Allergy Dokuz Eylül University Medical Faculty for at least one year with mild persistant and moderate persistent asthma. The patients were divided in to three groups: Group 1st used inhaled chromolin sodium 10 mg/per day, group 2nd used inhaled budesonid 400mcg/per day, group 3 used inhaled chromolin sodium 10 mg/per day and inhaled budesonid 400 meg/per day. All the groups were treated for six months. Physical examinations, bazal pulmonary function tests, liver-kidney function tests, serum total eosinophil count, epidermal skin tests ( skin prick tests), complete blood count anteroposterior chest roentgenogram were evalueted before the study during run in period. Symptom scores were constructed including clinical well being, exercise tolerance, compliance to elimination, state of mood and the freqency of night time awakenings. Monthly |3-2 agonist requirements were determined. The cardiac functions were evaluated echocardiographically both before and after treatment. The patients were seen monthly during the treatment period and pulmonary function tests, physical examinations and symptom scores were recorded. Of the 63 patients in the study, 26 (41.26%) were girls and 37 (58.74%) were boys. The study was completed with 61 patients, since one was unavailable for follow up and one other was excluded due to worsening of asthma.. There was no statistically significant difference between the groups with respect to age, sex, weight and height (p>0.05). 10Two patients 3.17%) had the common cold, two patients (3.17%) had pharyngitis, and two patients (3.17%) had abdominal pain before the treatment started. Eleven patients (17.46%) were included in the study after they were treated with antibiotics (seven for acute sinusitis and four for pharyngitis). Pre and post- treatment hematological, biochemical and serological parameters were not different between the groups (p>0.05). All of chest roentgenograms were normal and skin prick test were positive. Post-treatment FVC, FEV1, FEF 25-75 and PEF values, increased statistically significant in all three groups (p< 0.05). Monthly bronchodilatotor requirement decreased significantly in all groups, but statistically significant improvement was possible in the group which using inhaled corticosteroids (p<0.05). However, decreased bronchodilatotor requirement in group three reached 95% in the early phase of the treatment. The clinical improvement, increase in exercise capacity and decrease in the frequency of night time awakening were statistically significant in all groups (p<0.05). In group 1, compliance to elimination had statistical significance (p:0.01); but in group 2 and 3 this significance was not observed (p> 0.05). The state of mood of our patients was evaluated and scored as below: "0" normal (there is nothing wrong), "1" very good, "2" good, "3" the same, "4" bad, "5" very bad, "6" very very bad. The validity of the answers given was compared statistically pre and post- treatment. There was no statistically significant difference with respect to mood in group 2 (p>0.05), but were statistically significant difference in group 1 and 3 (p< 0.05). A statistically significant improvement was found in all three groups, with respect to clinical findings, pulmonary function tests and symptom scores (p<0.05). When the patients were evaluated for the side effects, no significant increase was noted in any of the groups during the active treatment period with respect to the run in period ( p>0.05). Pre and post-treatment electrocardiographic and echocardiographic parameters were evaluated in order to see the cardiac functions in patients using regular treatment and to see the cardiac side effects of the drugs used in the treatment. There was no statistically significant difference in all groups (p>0.05). In conclusion, the result of this study demonstrate that disease activity of the children with mild and moderate persistent asthma could be controlled all three treatment regimens, being more prominent in the groups given inhaled corticosteroids alone and inhaled corticosteroids together with inhaled chromolin sodium. Chromolin sodium could 11be used with safety in mild asthma but if the symptoms do not improve it is necessary to start inhaled corticosteroids. Since the improvement in pulmonary function tests and in the clinical course is similar between the group 2 and 3. This study shows that; adding chromolin sodium in the group which need to use inhaled corticosteroids doesn't affect the treatment. In patients using regular treatment for asthma, the electrocardiographic and echocardiographic parameters don't show any change in cardiac functions. Also, the Ion- term use of the drugs do not have any cardiac side effects. Key Words: Bronchial asthma, inhale budesonid, inhale chromolin sodium, echocardiography. 12