A bioassay for topical and systemic effect of three inhaled corticosteroids*

McCubbin, Michael; Milavetz, Gary; Grandgeorge, Steve; Weinberger, Miles; Ahrens, Richard C.; Sargent, Constance; Vaughan, Leigh M.

doi:10.1016/0009-9236(95)90216-3

Cited by 41 publications

(28 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…99,100 In another 12-month study comparing monotherapy with beclomethasone dipropionate via pressurized metered-dose inhaler, 0.336 mg/d, or optimized twicedaily theophylline, beclomethasone resulted in comparable symptom control with less bronchodilator use, fewer res- * References 23,31,42,44,46,49,50,54,56,58,68,70,72,73,75,[88][89][90][91][92][93]42,44,46,54,65,88,92,94,95. cue courses of systemic steroids, and fewer side effects, although beclomethasone resulted in a 1.6-cm/y reduction in height velocity that was most pronounced in boys. 103 A 7-month study also showed a 1-cm reduction in height velocity comparing dry-powder beclomethasone dipropionate, 0.4 mg/d, and placebo, although this was not associated with any detectable effect on urinary cortisol levels or biochemical bone markers.…”

Section: Growthmentioning

confidence: 99%

Systemic Adverse Effects of Inhaled Corticosteroid Therapy

1999

View full text Add to dashboard Cite

Objective: To appraise the data on systemic adverse effects of inhaled corticosteroids.Methods: A computerized database search from January 1, 1966, through July 31, 1998, using MEDLINE, EMBASE, and BIDS and using appropriate indexed terms. Reports dealing with the systemic effects of inhaled corticosteroids on adrenal gland, growth, bone, skin, and eye, and reports on pharmacology and pharmacokinetics were reviewed where appropriate. Studies were included that contained evaluable data on systemic effects in healthy volunteers as well as in asthmatic children and adults. A statistical meta-analysis using regression was performed for parameters of adrenal suppression in 27 studies.Results: Marked adrenal suppression occurs with high doses of inhaled corticosteroid above 1.5 mg/d (0.75 mg/d for fluticasone propionate), although there is a considerable degree of interindividual susceptibility. Metaanalysis showed significantly greater potency for doserelated adrenal suppression with fluticasone compared with beclomethasone dipropionate, budesonide, or triamcinolone acetonide, whereas prednisolone and fluticasone propionate were approximately equivalent on a 10:1-mg basis. Inhaled corticosteroids in doses above 1.5 mg/d (0.75 mg/d for fluticasone propionate) may be associated with a significant reduction in bone density, although the risk for osteoporosis may be obviated by postmenopausal estrogen replacement therapy. Although medium-term growth studies showed suppressive effects with 400-µg/d beclomethasone dipropionate, there was no evidence to support any significant effects on final adult height. Long-term, high-dose inhaled corticosteroid exposure increases the risk for posterior subcapsular cataracts, and, to a much lesser degree, the risk for ocular hypertension and glaucoma. Skin bruising is most likely to occur with high-dose exposure, which correlates with the degree of adrenal suppression.Conclusions: All inhaled corticosteroids exhibit doserelated systemic adverse effects, although these are less than with a comparable dose of oral corticosteroids. Metaanalysis shows that fluticasone propionate exhibits greater dose-related systemic bioactivity compared with other available inhaled corticosteroids, particularly at doses above 0.8 mg/d. The long-term systemic burden will be minimized by always trying to achieve the lowest possible maintenance dose that is associated with optimal asthmatic control and quality of life. Med. 1999;159:941-955 Arch Intern

show abstract

Section: Growthmentioning

confidence: 99%

Systemic Adverse Effects of Inhaled Corticosteroid Therapy

1999

View full text Add to dashboard Cite

show abstract

“…One study suggests that the three inhaled glucocorticoids available in the United States, beclomethasone dipropionate, triamcinolone acetonide and flunisolide, are equal in efficacy and systemic adverse effects when compared on a dose per dose basis [35]. Therefore, this study concludes that the relative potency per inhalation is approximately proportional to the dose delivered.…”

Section: Approach To Managementmentioning

confidence: 75%

Glucocorticoid-resistant asthma: pathogenesis and clinical implications for management

Szefler¹,

Leung²

1997

Eur Respir J

View full text Add to dashboard Cite

At the present time, emphasis is placed on viewing asthma as a manifestation of chronic airway inflammation, possibly secondary to allergen hypersensitivity. Consequently, one aspect of management is to institute measures of environmental control to minimize the inflammatory response related to allergen stimulation, and to administer anti-inflammatory therapy to resolve inflammation and prevent progression of disease.Most patients respond very favourably to conventional therapy, as recommended in recent guidelines for asthma management. Some cases, however, remain very difficult to control despite high-dose inhaled glucocorticoids, even combined with oral glucocorticoid therapy. Management of these patients raises questions about the conditions that alter response to glucocorticoid therapy.The patient with difficult to control asthma not only presents a challenge to clinical management but raises new questions concerning our ability to control the progression of disease. Is difficult to control asthma secondary to overwhelming or ongoing allergen exposure? Do anti-inflammatory medications, specifically inhaled glucocorticoids, really control the progression of the disease? Are these patients destined to become severe asthmatics at birth due to the inherent characteristics of their airways, or is this indeed a consequence of progressive inflammation?This review will summarize present concepts of glucocorticoid-resistant asthma, current knowledge of the mechanisms of persistent inflammation, and the implications for management. The gaps in information will also be addressed in order to stimulate interest in further research that could lead to better understanding of the disease and potential windows for therapeutic intervention.

show abstract

“…More investigators have recently attempted to utilize allergen challenge as a model for testing relative potency of ICS [120][121][122]. The first published paper was, unfortunately, not randomized.…”

Section: Laboratory Models For Relative Potency Of Inhaled Corticostementioning

confidence: 99%

“…The first published paper was, unfortunately, not randomized. Increasing doses of ICS were administered at 1 week intervals in sequentially increasing doses [120]. The resulting apparent increase in inhibition of the allergen-induced EAR may well have related to the increasing duration of treatment rather than to the increasing doses administered.…”

Section: Laboratory Models For Relative Potency Of Inhaled Corticostementioning

confidence: 99%