Effect of 1 year daily treatment with 400 microg budesonide (Pulmicort Turbuhaler) in newly diagnosed asthmatics

Abstract

The aim of this study was to investigate whether treatment with a low daily dose of 400 µg inhaled budesonide (Pulmicort® Turbuhaler®) in newly diagnosed asthmatics could influence the course of asthma.Seventy five adult patients, mostly with mild asthma, diagnosed during the previous year and bronchial hyperresponsiveness, participated in a double-blind, randomized, parallel-group multicentre study. They were treated with budesonide 200 µg b.i.d. or placebo, delivered via Turbuhaler® for 12 months and followed-up for another 6 months without inhaled steroid treatment. Airway function, symptom scores, reactivity to histamine and inflammatory indices in blood were assessed.The mean increase in morning peak expiratory flow (PEF) was 28 L·min -1 after budesonide treatment compared with no increase in the placebo group (p=0.011). The provocative dose of histamine causing a 20% fall in forced expiratory volume in one second (PD20) (geometric mean) increased in the budesonide group by approximately two doubling dose steps, but not in the placebo group (p=0.0003). The difference between groups with regard to improvement in asthma symptom scores and inflammatory indices did not reach statistical significance. During the 6 month follow-up, the PEF values of the patients who had previously been treated with budesonide decreased by 18 L·min -1 while the PD20 decreased by approximately one doubling dose step.In conclusion, early treatment with a low dose of budesonide improves airway function and decreases bronchial responsiveness, but the improvements are shortlasting without continued treatment.

Glucocorticoids: mechanisms of action and anti‐inflammatory potential in asthma

“…134,[167][168][169] In contras t to the rapid inhibitor y effe cts of b 2 -agonis ts, gluc ocortic oids give n in a single dose are not effe ctive in pre venting early alle rgen-invo ke d bronchocons triction, but inhibitio n of the late re sponse has be en clearly demonstrate d. 170,171 In contras t, chronic tre atme nt w ith either oral or inhale d ste roids atte nuate s e ve n the early bronchoconstric tion to alle rge n, [171][172][173] an effe ct that probably is mediate d via the antiinflammator y actions of glucoc ortic oids alre ady desc ribe d. Although inhale d glucocortic oids consis te ntly re duce airw ay hyperre ac tivity in asthmatics, 169 even afte r se veral months of tre atme nt re sponsive ne ss fails to re turn to the normal range . This may re flec t persis te nc e of struc tural change s that canno t be re verse d by ste roids (such as the thic kening of the baseme nt membrane ), despite of suppre ssion of the inflammator y and immunologic al proc esses.…”

Development of inhalable dry powder formulation of basic fibroblast growth factor

“…Conventional therapy for asthma and COPD is based on antiinflammatory drugs and bronchodilators, such as corticosteroids (Osterman et al, 1997), leukotriene modifiers (Fanta, 2009), cromolyn (Fanta, 2009;Pleasants, 2006), ␤-adrenergic agonists (Pleasants, 2006;Fanta, 2009;Nathan, 1992), and anti-cholinergic agents (Pleasants, 2006). These drugs are typically administrated either systemically as oral dosage forms (Pleasants, 2006) or locally as inhalable dosage forms (Nathan, 1992), such as pressurized metered-dose inhalers (Pleasants, 2006;Fanta, 2009), dry powder inhalers (Osterman et al, 1997), or nebulizers (Fanta, 2009;Pleasants, 2006).…”

“…These drugs are typically administrated either systemically as oral dosage forms (Pleasants, 2006) or locally as inhalable dosage forms (Nathan, 1992), such as pressurized metered-dose inhalers (Pleasants, 2006;Fanta, 2009), dry powder inhalers (Osterman et al, 1997), or nebulizers (Fanta, 2009;Pleasants, 2006).…”

Inhaled Corticosteroids for Asthma: Common Clinical Quandaries

“…This and similar studies (19,20) demonstrate the benefits of starting inhaled corticosteroid therapy as early as possible in newly diagnosed asthmatics, with the maximum benefit if commenced within 2 years of making a diagnosis of asthma. In order to make firm recommendations, it is necessary to understand whether early therapy can affect the evolution of newly diagnosed asthma.…”