Ww. Busse et al., Efficacy response of inhaled beclomethasone dipropionate in asthma is proportional to dose and is improved by formulation with a new propellant, J ALLERG CL, 104(6), 1999, pp. 1215-1222
Background: This study tested the hypothesis that there mould be improved a
sthma control with increasing doses of beclomethasone dipropionate (BDP) fo
rmulated in hydrofluoroalkane-134a (HFA-BDP) and the standard chlorofluoroc
arbon propellants (CFC-BDP), Because HFA-BDP has improved lung deposition c
ompared with CFC-BDP, this study also tested the hypothesis that HFA-BDP wo
uld provide more effective control of asthma than CFC-BDP,
Methods: In this multicenter, randomized, parallel-group blinded study, ast
hmatic subjects who had deterioration in asthma control after discontinuati
on of inhaled corticosteroids were randomized to receive one of 6 possible
treatments: 100 mu g/d, 400 mu g/d, or 800 mu g/d of HFA-BDP or 100 mu g/d,
400 mu g/d, or 800 mu g/d of CFC-BDP for 6 weeks. Changes in spirometry, d
aytime asthma symptom and nighttime asthma-related sleep disturbance scores
, morning and evening peak expiratory flows, and daily use of inhaled beta-
agonist for symptom control on diary cards were assessed over 6 weeks of tr
eatment.
Results: Three hundred twenty-three patients mere randomized to the 6 treat
ment groups, which had similar demographics and baseline lung function, The
re were significantly larger changes from baseline at week 6 in FEV1 percen
t predicted with increasing doses of both HFA-BDP and CFC-BDP, The FEV1 per
cent predicted dose-response curve for HFA-BDP was shifted to the left comp
ared with the dose-response curve for CFC-BDP, By using the Finney bioassay
method, it was calculated that 2.6 times as much CFC-BDP would be required
to achieve the same improvement in FEV1 percent predicted as HFA-BDP (95%
confidence interval, 1.1-11.6), All treatment groups except the 100 mu g/d
CFC-BDP group tolerated study drug well, Ten (17%) of 59 patients in this g
roup reported an acute asthma episode, increased asthma symptoms (6 of the
8 reports of increased asthma symptoms were classified as severe), or both,
and 8 patients withdrew from the study (3 for adverse events related to as
thma),
Conclusions: Increasing doses of inhaled corticosteroids lead to improved l
ung function and asthma control. Moreover, the reformulation of BDP in HFA
enables effective asthma control at much lower doses than CFC-BDP.