Beclomethasone, budesonide and fluticasone significantly improved clinical and functional parameters in patients with asthma, as well as allow reduce the dose of systemic steroids in steroid patients.

Budesonide

effectiveness of budesonide was also subjected to a meta-analysis [3].
met the inclusion criteria 43 randomized trials (n =
2801), in which budesonide was compared with placebo in asthma in adults and children . I
patients not receiving oral steroids, budesonide significantly improved
functional parameters: FEV1 - by 3,7% predicted, morning PEF - 29
l / min.

Methods of clinical evaluation varied greatly, so
data integration was impossible, but all studies have shown
significant superiority of budesonide over placebo.
Budesonide reduced the risk of exit from the study due to exacerbation - OR 0,17.

One study showed a significant dose reduction or complete abolition of
prednisolone using budesonide. It should be noted that
budesonide did not differ from placebo the frequency of both local (pain in the throat, hoarseness),
and system (depression GGNS) adverse effects.

meta-analysis of effects depending on the dose of budesonide [4]
based on 24 studies (n = 3907). Among the patients with mild to moderate asthma
not receiving oral steroids was not clinically significant
differences between doses in the range of 200-1600 mg / d on indicators of FEV1, PSV and
needs beta2-agonists. In moderate and severe asthma, however, the risk
exacerbation was lower in the treatment dose of 800 micrograms / day compared with 200 mg / day.
In severe asthma dose of 1600 mg daily dose exceeded 200 mg / day to improve FEV1
(but not PSV). Sparring_effekt in steroid-dependent patients did not differ between doses
1600 vs 400-800 mg / day.

GGNS suppression (reduced secretion of endogenous cortisol) was significant and dose-dependent
in the range of 800-3200 mg / day.

fluticasone propionate

fluticasone propionate (FP) - a relatively new inhaled corticosteroids, but
meta-analysis of its effectiveness in asthma [5], including 28
randomized studies of high methodological quality (n = 5788). Compared with placebo
PT led to an increase in FEV1 by 310 ml, morning PEF of 29 l / min,
reduced clinical symptoms and the need for .2 _agonistah ( to 1.1 doses in
day).

High-dose OP (1000 - 1500 mg / day) will undo
oral steroids in some steroid-dependent patients. PT in any dose causes
increase the likelihood of sore throat, hoarseness and oral candidiasis.
Thus, the dose of FP 100-1000 mg / day are effective.
Despite the dose-response of this effect in patients with mild and moderate asthma high doses of FP
cause only a slight additional improvement as compared with less.
Similar findings were obtained by direct analysis of the relationship between effects and
doses of PT [6] (20 randomized trials ofmorethan 6000 patients). In
patients mild to moderate asthma were dose-dependent effect on morning PEF:
difference between the effect of high (800-1000 mg / day) and low (50-100 mg / day) doses
FP was 22 L / min. The effect on the symptoms and the need for beta2-agonists are not
was dose dependent. dysphonia and oral candidiasis occurred significantlymorefrequently
when using high doses of FP (800-1000 mg / day) than with low
doses (50-100 mg / day).

dose of 2000 mg / day prednisolone can cancel or reduce the dosage
a larger number of steroid-dependent patients than the doses of 1000 - 1500 mg / day.
can conclude that the effects of the PT dose related to a small extent.
Very high doses of FP (2000 mg / day) have an advantage in steroid-dependent patients
for reducing the dose of oral steroids, but patients with mild and moderate asthma
low-dose FP (200 mcg / day) provide almost the same control
disease, as well as high-dose (500 mg / day and more).

Comparative efficacy of inhaled corticosteroids Budesonide vs BJP

Comparison of the effectiveness of budesonide and the BJP was carried out at
meta-analysis prospective randomized studies that directly compared these dasgs
[7]. served as the basis of these 24 studies (n =
1174). Meta-analysis of cross-sectional studies found no significant differences between
budesonide and beclomethasone in the dose range 400 - 1000 mcg / day for effects on
FEV1, morning and evening PEF, asthma symptoms and the need for beta2-agonists.
It should be noted, however, that most of these studies had flaws in
design (lack of washout period and etc.), which is why we can not exclude
overlapping effects of comparing dasgs. The only work with
adequate washout period showed that budesonide in a dose of 400 mg / day
(unit of delivery - dry powder inhaler Turbuhaler) perhapsmore
reduces bronchial hyperreactivity in comparison with the BJP
(dry powder inhaler Rotahaler) with the same dose. In a meta-analysis studies have
adults, in which a dose of inhaled corticosteroids was reduced to the smallest effective, noted that the
for the control of asthma symptoms rather lower for 444 mg / day dose of budesonide (Turbuhaler)
compared with the BJP (via metered dose aerosol inhaler with a spacer or
without him).

Currently, there are very few
high quality research on the comparative effectiveness of budesonide and the BJP.
Data unit tests on large necks effectiveness of budesonide (Turbuhaler) in
compared with the BJP (Rotahaler or dose aerosol inhaler ) may be related to differences
delivery device. So long as there is no reason to change recommendations
existing guidelines, in which budesonide and BDP
deemed to be equal in effectiveness, and their recommended doses of the same
severity of asthma match.

FP vs BDP / budesonide

When conducting meta-analysis of the effectiveness of PT as compared to the BJP and
budesonide [8] found 42 randomized trials (n> 10,000).
When comparing PT with the BJP and budesonide in a dose ratio of 1: 2 FP had great
effect on FEV1 (110 ml), PSV Eindhoven (13 l / min).
This pattern was typical for all doses, the age ranges and delivery devices, although
analysis by subgroups showed a greater advantage of the PT inmoresevere patients,
receiving high-dose inhaled corticosteroids. presented data on clinical symptoms and
needs beta2-agonists was not enough to conduct the analysis.
same ratio of doses at the PT likelihood of sore throat was greater than that of
BJP / budesonide, although the frequency of oral candidiasis compared
dasgs were not significantly different. The authors conclude that a 2-fold lower compared with the BJP / budesonide
dose of FP leads to a small functional improvements related, however, with
increased risk of adverse effects.

Adverse effects of inhaled corticosteroids

Called ICS local adverse effects (sore throat,
dysphonia, oral candidiasis) discussed above.
System undesirable effects meta-analysis is devoted to two Cochrane Library [9, 10]. The first of these
assess the effects of inhaled corticosteroids on bone metabolism in adult patients with asthma or COPD
[9]. of 428 studies, only 7 were randomized placebo-controlled
. Most of the patients were younger than 60 years. The analysis revealed no
evidence of increased loss of bone density or fracture risk
in the treatment of inhaled corticosteroids. When using conventional doses of inhaled corticosteroids also had no significant changes in osteocalcin
, although they were observed when the dose of inhaled corticosteroids
exceed recommended. Thus, there is no evidence of influence
2-3-year treatment of conventional doses of inhaled corticosteroids on bone density or fracture risk
. Higher doses lead to changes in biochemical markers of bone metabolism
. Lookingmorelong-term prospective studies
both conventional and high doses of inhaled corticosteroids.

Another review is devoted to the influence of beclomethasone on linear growth
children with asthma [10]. BJP was chosen because it has a significant systemic
bioavailability. Of the 159 studies, which addressed the problem of growth,
were selected 3 randomized trials comparing BDP with placebo or nonsteroidal dasg
stascture. All the papers used BDP 200 mcg 2
times a day via dry powder inhaler Diskhaler in children with mild / moderate asthma
.

duration of observation was 7-12 months.
In all studies found significant delay in linear growth in the treatment of the BJP,
averaged 1.54 cm per year.

Since the studies lasted less than a year, it remains unclear,
whether it is an irreversible growth retardation, or children "catching up" peer
after the abolition of inhaled corticosteroids. Survey results should not be generalized to other ICS,
have less systemic bioavailability. If you want to treat children
inhaled corticosteroids should be prescribed the minimum effective dose that controls asthma symptoms.

List of literature

1. Adams NP et al. Inhaled beclomethasone versus placebo for
chronic asthma (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford:
Update Software. ab002738-20021.

2. Adams NP et al. Inhaled beclomethasone at different doses
for chronic asthma (Cochrane Review). ab002879-20021.

3. Adams NP et al. Budesonide for chronic asthma in children
and adults (Cochrane Review). ab003274-20021.

4. Adams NP et al. Inhaled budesonide at different doses for
chronic asthma (Cochrane Review). ab003271-20021.

5. Adams NP et al. Inhaled fluticasone proprionate for chronic
asthma (Cochrane Review). ab003135-20021 .

6. Adams NP et al. Inhaled fluticasone at different doses for
chronic asthma (Cochrane Review). ab003534-20021.

7. Adams NP et al. Inhaled beclomethasone versus budesonide
for chronic asthma (Cochrane Review). ab003530-20021.

8 . Adams NP et al. Fluticasone versus beclomethasone or
budesonide for chronic asthma (Cochrane Review). ab002310-20021.

9. Jones A. et al. Inhaled corticosteroid effects on bone
metabolism in asthma and mild chronic obstasctive pulmonary disease (Cochrane
Review). ab003537-20021.

10. Sharek PJ et al. Beclomethasone for asthma in children:
effects on linear growth (Cochrane Review). ab001282-20021.