Effect of HFA-flunisolide on peripheral lung inflammation in asthma

Background: New hydrofluoroalkane (HFA) formulations of glucocorticoids have been shown to effectively control asthma. HFA glucocorticoids are deposited across all sizes of airways, including the small ones. However, it is not clear whether they can suppress peripheral airway inflammation. Objective: We sought to determine whether HFA-flunisolide could suppress peripheral inflammation in asthma. Methods: Twelve patients with mild to moderate asthma received HFA-flunisolide for 6 weeks. Transbronchial and endobronchial biopsy specimens were obtained before and after treatment, and spirometry was performed. Changes in inflammatory cells (eosinophils, neutrophils, lymphocytes, macrophages, basophils) and IL-5 and eotaxin were measured by using immunocytochemistry and in situ hybridization. Results: Lung function significantly improved after treatment (P < .05). HFA-flunisolide significantly reduced eosinophils, IL-5, and eotaxin in both peripheral and central airways (P < .01). Neutrophils significantly increased after treatment in peripheral and central airways (P < .05). The numbers of lymphocytes remained unchanged. Conclusions: These results show that HFA-flunisolide effectively suppressed eosinophilic inflammation in peripheral and central airways. These changes were accompanied by improvement in lung function.