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Compares the efficacy of budesonide Turbuhaler with that of beclomethasone dipropionate pMDI in Japanese patients with persistent asthma. Basis in comparing the outcomes; Approach for improving the efficacy of budesonide; Importance of a higher dose treatment when comparing two formulations.

Objective:The aim of this study was to evaluate the oral steroid-sparing capacity of budesonide Turbuhaler®. Methodology:One hundred and thirteen oral steroid-dependent patients were treated for 6 months with placebo or budesonide 800 μg or 1600 μg daily. Every second week the oral steroid dose was reduced if asthma control permitted. Results:The reductions in oral steroid doses were 9, 35 and 60% in the placebo and budesonide 800 μg and 1600 μg groups, respectively. Oral steroid treatment could be discontinued in 4% (placebo), 15% (800 μg) and 23% (1600 μg). Mean peak expiratory flow values increased by 21 and 24 L/min in the budesonide groups but decreased by 6 L/min in the placebo group. Asthma attack, activity and sleep scores remained unchanged showing maintained efficacy. Plasma cortisol levels increased and an adrenocorticotropic hormone test showed improved adrenocortical response in both budesonide groups, indicating improved safety. Adverse drug reactions were infrequent and mild in all study groups. Conclusion:Budesonide Turbuhaler, 800 μg and 1600 μg daily, resulted in a significant reduction in oral steroid usage in steroid-dependent patients. The effect was achieved with maintained asthma control together with improvements in lung and adrenal functions. [ABSTRACT FROM AUTHOR]

The author discusses a study related to the Helsinki Early Intervention Childhood Asthma Programme which is a program that highlights the benefits and safety aspects of intermittent treatment of asthma with budesonide. Several graphs depicting findings of the study are also presented. The author concludes that intermittent treatment using inhaled corticosteroids is an efficient alternative for treating mild persistent asthma in children.

Background: In a previous study, we found that two years of treatment with an inhaled corticosteroid, budesonide, was more effective than treatment with an inhaled β2-agonist, terbutaline, in patients with newly diagnosed, generally mild asthma. We continued this study for a third year to investigate whether the steroid dose could be reduced or discontinued and what effect crossover of patients from β2-agonist therapy to corticosteroid therapy would have. Methods: A total of 37 patients treated for two years with inhaled budesonide at a dose of 1200 μg per day were randomly assigned to treatment with 400 μg of budesonide per day (19 patients) or placebo (18 patients) in a double-blind manner. Another 37 patients, who had received terbutaline during the first two years, were crossed over in an open-label manner to treatment with 1200 μg of budesonide per day during the third year. Results: Treatment with the reduced dose of budesonide was sufficiently effective in 74 percent of the patients to maintain bronchial responsiveness at a level similar to that achieved with the higher dose. In contrast, improvement was maintained in only 33 percent of the patients receiving placebo, and the differences in pulmonary function between the steroid and placebo groups were significant (for forced expiratory volume in one second, P = 0.007; for bronchial responsiveness to histamine, P = 0.025; and for peak expiratory flow in the morning, P = 0.040). The condition of patients who were crossed over from terbutaline therapy to treatment with 1200 μg of budesonide per day improved. However, the degree of improvement in these patients appeared to be less than in those who were treated with budesonide at the beginning of the three-year study. Conclusions: Early treatment with inhaled budesonide results in long-lasting control of mild asthma. Maintenance therapy can usually be given at a reduced dose, but discontinuation of treatment is often accompanied by exacerbation of the disease. (N Engl J Med 1994;331:700-5.) [ABSTRACT FROM AUTHOR]