Optimal asthma control, starting with high doses of inhaled budesonide (vol 16, pg 226, 2000)

Citation
Hk. Reddel et al., Optimal asthma control, starting with high doses of inhaled budesonide (vol 16, pg 226, 2000), EUR RESP J, 16(3), 2000, pp. 579-579
Citations number
1
Categorie Soggetti
Cardiovascular & Respiratory Systems","da verificare
Journal title
EUROPEAN RESPIRATORY JOURNAL
ISSN journal
09031936 → ACNP
Volume
16
Issue
3
Year of publication
2000
Pages
579 - 579
Database
ISI
SICI code
0903-1936(200009)16:3<579:OACSWH>2.0.ZU;2-Q
Abstract
The aim of this study was to determine whether outcomes in poorly controlle d asthma can be further improved with a starting dose of inhaled budesonide higher than that recommended in international guidelines. The study had a parallel-group design and included 61 subjects with poorly controlled asthma, randomized to receive 3,200 mu g or 1,600 mu g budesonid e daily by Turbuhaler(R) for 8 weeks (double-blind), then 1,600 mu g.day(-1 ) for 8 weeks (single-blind), followed by 14 months of open-label budesonid e dose down-titration using a novel algorithm, with a written asthma crisis plan based on electronic peak expiratory flow monitoring. The primary outc ome variable for weeks 1-16 was change in airway hyperresponsiveness (AHR), and, for the open-label phase, mean daily budesonide dose. By week 16, there were large changes from baseline in all outcomes, with no significant differences between the 3,200- and 1,600-mu g.day(-1) starting dose groups (AHR increased by 3.2 versus 3.0 doubling doses, p=0.7; mornin g peak flow increased by 134 versus 127 L.min(-1), p=0.8). Subjects startin g with 3,200 mu g.day(-1) were 3.8 times more likely to achieve AHR within the normal range, as defined by a provocative dose of histamine causing a 2 0% fall in forced expiratory volume in one second (PD20) of greater than or equal to 3.92 mu mol by week 16 (p=0.03). During dose titration, there was no significant difference in mean budesonide dose (1,327 versus 1,325 mu g .day(-1), p>0.3). Optimal asthma control was achieved in the majority of su bjects (at completion/withdrawal: median symptoms 0.0 days.week(-1), beta(2 )-agonist use 0.2 occasions.day(-1), and PD20 2.4 mu mol). In subjects with poorly controlled asthma, a starting dose of 1,600 mu g.da y(-1) budesonide was sufficient to lead to optimal control in most subjects . The high degree of control achieved, compared with previous studies, warr ants further investigation.