Efficiency of Inhaled Versus Oral Steroid Treatment of Chronic Asthma

Abstract

The therapeutic efficiency of oral vs. inhaled steroid treatment for chronic asthma was compared in several graded-dose. double-blind controlled trials. Inhaled steroid proved significantly more effective than alternate-morning prednisone when the two regimens were compared in the same patients at equivalent levels of systemic glucocorticoid activity. Furthermore. if given in sufficient dosage, inhaled steroids proved equally as effective as oral prednisone given daily. and better tolerated than the latter. The data support a broadening of the therapeutic role of inhaled steroid drugs to include higher dosages and patients with more severe grades of asthma. To facilitate this, concentratedformulations are needed. Until the latter become available to the practitioner. combinations of inhaled plus oral steroid treatment may be used. since these have been shown to improve the efficacy of chronic steroid therapy without worsening its adverse effects.98 not applicable to the treatment of patients with relatively severe chronic asthma. Furthermore, since doses of BDP greater than -I mg/day (or comparable doses of other inhaled steroids) show measurable systemic glucocorticoid activity, the use of high doses of these drugs is thought to confer no advantage over oral steroid in the treatment of severe asthmatics. Both these concepts are at odds with some observations made during several recent studies in whicl1 the clinical performance of oral prednisone was compared with that of the inhaled steroid, budesonide. Budesonide (BUD) is a topically active corticosteroid similar to BDP, but with a more favorable ratio of antiasthmatic to systemic activity.'Alternate-day Prednisone vs. Inhaled Budesonide B efore inhaled steroid therapy was introduced to America, low dose alternate-morning prednisone was the preferred steroid regimen for chronic asthma treatment. Its efficacy was established, and it had been shown to cause fewer adverse effects than divided dose or daily single-dose prednisone. 2 - 6 After a decade of clinical experience with BDP some uncertainty persists, particularly among American pediatricians, as to whether inhaled steroid drugs afford a clinically important advantage over low dose alternate-morning prednisone.2.8·9 A rationale has been proposed for considering the latter as the treatment of choice for many patients who need maintenance steroid therapy.2 The basis for this view is a perception that the two regimens are about equally effective; the observation that either may show evidence of systemic glucocorticoid activity at low dosage in some patients, if sufficiently sensitive tests of

Budesonide Attains Its Wide Clinical Profile by Alternative Kinetics

“…Patients controlled on oral prednisone 15 mg plus BDP 800 µg per day were treated with BUD 800 µg, 1600 µg, or 3200 µg and prednisone 15 mg, 30 mg, and 60 mg on alternate days using a doubleblind cross-over design. All doses of BUD were significantly better than any OC dose in improving lung function and symptoms [50,51]. Thus, with BUD, it was possible to stop or significantly reduce the doses of OC.…”

“…The relative potency of BUD and OC was compared in studies by Toogood et al [50]. Patients controlled on oral prednisone 15 mg plus BDP 800 µg per day were treated with BUD 800 µg, 1600 µg, or 3200 µg and prednisone 15 mg, 30 mg, and 60 mg on alternate days using a doubleblind cross-over design.…”

The Pharmacological Treatment of Voice Disorders

“…Delivery systems affect where the drug is deposited in the airway [6. 7], Where it is necessary to treat asthma in a performer, the routine use of a spacer with the inhaler and postinhalational breath holding maximize the steroid deposited in the lower respiratory tract and minimize deposition in the laryngopharynx [8], In general, there arc fewer side-effects associated with inhaled ste roids than with therapeutically equivalent doses of systemic steroids such as predniso lone [9], but phoniatricians contemplating re challenging patients with a history of inhaled steroid-induced hoarseness should be aware that on study found a 60% recurrence rate [ 10].…”