Inhaled budesonide for adults with mild-to-moderate asthma
a randomized placebo-controlled, double-blind clinical trial
Keywords:
Asthma, Inhaled corticosteroid, BudesonideAbstract
CONTEXT: Budesonide is an inhaled corticosteroid with high topical potency and low systemic activity recommended in he treatment of chronic asthma. OBJECTIVE: This study was conducted to determine the efficacy and safety of inhaled budesonide via a breath-activated, multi-dose, dry-powder inhaler. TYPE OF STUDY: Multicenter randomized parallel-group, placebo-controlled, double-blind, clinical trial. SETTING: Multicenter study in the university units. PARTICIPANTS: Adult patients with mild-to-moderate asthma that was not controlled using bronchodilator therapy alone. PROCEDURES: Comparison of budesonide 400 µg administered twice daily via a breath-activated, multi-dose, dry-powder inhaler with placebo, in 43 adult patients (aged 15 to 78 years) with mild-to-moderateasthma(FEV171%ofpredicted normal) that was not controlled using bronchodilator therapy alone. MAIN MEASUREMENTS: Efficacy was assessed by pulmonaryfunction tests and asthma symptom control (as perceived by the patients) and the use of rescue medication. RESULTS: Budesonide 400 µg (bid) was significantly more effective than placebo in improving morningpeakexpiratoryflow(meandifference: 67.9 l/min; P < 0.005) and FEV1 (mean difference: 0.60 l; P < 0.005) over the 8-week treatment period. Onset of action, assessed by morning peak expiratory flow, occurred within the first two week sof treatment. CONCLUSIONS: Budesonide via a breath-activated, multi-dose,dry-powder in haler results in a rapid on set of asthma control, which is main tained over time and is well tolerated in adults with mild-to- moderate asthma.
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References
Cochrane GM, Jackson WF, Rees PJ. Epidemiology of asthma. In: Asthma current perspectives, London: Mosby-Wolfe; 1996:5-12.
Peat JK, Van Den Berg RH, Green WF, et al. Changing prevalence of asthma in Australian children. Br Med J 1994;308:1591-6.
Fritscher CC, Severo RD, Fagundes SC. Modifications in the prevalence of asthma in schools in Porto Alegre. J Pneumol 1994;20:6-10.
Barnes NC, Hallet C, Harris AJ. Clinical experience with fluticasone propionate in asthma: meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half microgram doses or less. Respir Med 1998;92:95-104
Barnes NC, Thwaites RM, Price MJ. The cost-effectiveness of inhaled fluticasone propionate and budesonide in the treatment of asthma in adults and children. Respir Med Jun 1999;93:402-7
Konig P. Inhaled corticosteroids: their present and role in the management of asthma. J Allergy Clin lmmunol 1988;82:297-306.
Benson HA, Prankerd RJ. Optimization of drug delivery: pulmonary drug delivery. Aust J Hosp Pharm 1998;28:18-23.
National Heart, Lung and Blood Institute (NHLBI); National Institutes of Health. Executive summary: Guidelines for the diagnosis and management of asthma (Publication no. 91, 3042A). Bethesda: NHLBI; 1991:1-3.
Sociedade Brasileira de Alergia e Imunopatologia; Sociedade Brasileira de Pediatria; Sociedade Brasileira de Pneumologia e Fisiologia. I Consenso Brasileiro no Manejo da Asma. Fortaleza: 1994.
National Heart, Lung and Blood Institute (NHLBI); National Institutes of Health. Global initiative for asthma: global strategy for asthma management and prevention. NHLBI/WHO (Workshop Report Publication no. 95, 3659). Bethesda: NHLBI; 1995.
Sociedade Brasileira de Alergia e Imunopatologia; Sociedade Brasileira de Pediatria; Sociedade Brasileira de Pneumologia e Fisiologia. II Consenso Brasileiro no Manejo da Asma, 1998. J Pneumologia 1998;24:171-276.
Hatoum HT, Shumock GT, Kendziersk DL. Meta-analysis of controlled trials of drug therapy in mild chronic asthma: the role of inhaled corticosteroids. Ann Pharmacother 1994;28:1285-9.
Consenso Brasileiro de Espirometria. J Pneumologia 1996;22(3):103-57.
Sourk RL, Nugent KM. Bronchodilator testing: confidence intervals derived from placebo inhalations. Am Rev Respir Dis 1983;128:153-7.
Woolcock S, Lundback B, Ringdal N, et al. Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 1996;153:1481-8.
Pauwels RA, Löfdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma: Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997;337:1405-11.
Busse W, Maisiak R, Young Jr R. Treatment regimen and side effects of treatment measures. Am J Respir Crit Care Med 1994;149:S44-S50.
Kemp J, Wanderer AA, Ramsdell J, et al. Rapid onset of control with budesonide Turbohaler in patients with mild-to-moderate asthma. Ann Allergy Asthma Immunol 1999;82:463-71
Busse W, Chervinsky P, Condemi J, Lumry WR, Petty TL, Rennard S, Townley RG. Budesonide delivered by Turbohaler is effective in a dose-dependent fashion when used in the treatment of adult patients with chronic asthma. J. Allergy Clin Immunol 1998;101(3):457-63
Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests, asthma outcome. Am J Respir Crit Care Med 1994;149:S9-S18.
Tattersfield AE, Postma DS, Barnes PJ, et al. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am J Respir Crit Care Med 1999;160:594-9.