[A case of severe persistent bronchial asthma who showed significant improvement by switching to hfa-bdp, with reducing the dosage of oral steroids].

A case, 54-year-old female teacher, has been treated for severe persistent asthma mainly with an inhaled corticosteroid, budesonide (BUD), 600 microg/day. The higher dose was considered inappropriate due to the adverse effects including hoarseness, thus, prednisolone (PSL) was frequently given when needed. In this situation, administration of hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP), 400 microg/day, was started instead of BUD, and then improvement of the clinical symptoms, PEF and pulmonary function were observed promptly, followed by reduction in the dosage of PSL and a short-acting beta-stimulant. With higher doses of HFA-BDP, her pulmonary condition improved more remarkably. The levels of ECP, Eotaxin and RANTES in induced sputum obtained by inhalation of 10%-hypertonic saline were measured prior to the medication change and after one year, and all of the levels were found to be decreased, from 19000 to 96.0 microg/L, from 410 to 319 pg/ml, and from 281 to 85.1 pg/ml, respectively, indicating improvement of the condition. The overall score of Asthma Quality of Life Questionnaire by Juniper also improved from 5.3 to 6.6 points after one year. In this case study, it was suggested that HFA-BDP may reduce eosinophilic inflammation remained in the peripheral airway, and may be effective in supplementing the activity of PSL which must be taken orally by severe asthmatic patients.