Pulmonary Function Tests
The average FEVi for the patients was unchanged throughout the one-year trial. There was also no significant change in the FVC, FEF25-75%, FEF50%, or FEF75% (Fig 1).
Oral Requirement for Corticosteroids
One patient (patient 15) failed to benefit after two months of aerosol therapy, and he withdrew himself from the study. Of the remaining 22 patients, 16 no longer required maintenance therapy with prednisone for control of asthma after 12 months of aerosol therapy, and four patients tolerated a substantial reduction of their requirement for prednisone to a small altemate-day dose (Table 3).
There was no significant increase in the requirement or request for additional bronchodilator drugs by any patient during the study, although the patients were usually taking as large a dose as they could tolerate before the study. Two patients (patients 7 and 18) who had previously demonstrated improvement with inhalation of cromolyn sodium stopped using it because of their lack of symptoms of asthma while receiving triamcinolone acetonide aerosol. Two patients (patients 7 and 8) experienced control of asthma without oral therapy with steroids but required resumption of daily systemic therapy with steroids after two months without them because of incapacitating lethargy and myalgia. All patients who were being treated orally with steroids on alternate days prior to the study were able to control their asthma with triamcinolone acetonide aerosol alone.
Patients experiencing the most exacerbations of asthma were those who continued to require oral maintenance therapy with steroids during the one-year trial. The greatest requirement for additional oral therapy with steroids occurred during September, October, and November. There was no significant change in the frequency of apparent upper respiratory infections during any two-month period of the study.Elimination or maximal reduction of oral requirements for steroids was achieved safely within the first four months of the study (Fig 2). Increasing the dose of triamcinolone acetonide aerosol to 500/xg four times daily did not permit any further decrease in the dose of prednisone for those patients who continued to require oral therapy with steroids beyond four months. Six patients tolerated rapid reduction of the oral dosage of steroids during the first two months. Beyond the first four months, the average requirement for prednisone per patient remained at a low level, varying slightly with seasonal allergenic exposures and considerably with respiratory infections. Beyond six months, two patients experiencing exacerbations of asthma required 40 to 80 mg of prednisone daily for three to five weeks to regain control of symptoms reduced with remedies of Canadian Health&Care Mall. Continue reading “Canadian Health&Care Mall: Outcomes of A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma”