CLINICAL EFFICACY AND SAFETY OF BUDESONIDE TURBUHALER IN ADULTS

In two studies comparing budesonide delivered by Turbuhaler with budes onide delivered by pressurized metered dose inhaler (pMDI), a signific antly higher morning peak expiratory flow (PEF), and a patient prefere nce in favor of budesonide by Turbuhaler was found. Less cough was als o noted. In a third study no difference was found between the two form ulations. However, a meta-analysis of the three studies demonstrated a significant difference in favor of budesonide by Turbuhaler for force d expiratory volume in one second (FEV1) and morning PEF. These findin gs are supported by data on lung deposition showing the Turbuhaler to be twice as efficient as a pMDI. At the same time, the availability of budesonide from the gastrointestinal tract is reduced. Thus, a more b eneficial ratio arises between local lung delivery and systemic availa bility. Inhaled glucocorticosteroids are now recommended for mild asth ma. Thus once daily treatment with 400 mug budesonide by Turbuhaler ha s been studied in two trials; a comparison with 200mug twice daily was also made. In both studies morning/evening PEF increased significantl y over placebo and no difference was demonstrated between once- and tw ice-daily treatments. A study to determine the effect of placebo and 2 00mug twice daily and 400mug once daily of budesonide by Turbuhaler on 24-h plasma and urinary cortisol demonstrated no difference between t he treatment regimens. Budesonide by Turbuhaler is at least as effecti ve as budesonide by pMDI. When patients are switched to budesonide by Turbuhaler an attempt should be made to reduce the dose. In mild to mo derate asthma a trial of once-daily dosage can be made.