Comparative efficacy of inhaled ciclesonide, budesonide, and fluticasone in mild to moderately persistent bronchial asthma
Keywords:
Ciclesonide, Budesonide, Fluticasone, Asthma, SpirometryAbstract
Background: Bronchodilators and glucocorticoids have been proven to be very effective and safe in asthma treatment, which recommend the use of steroids and β2-agonist (long or short acting) as the first line of treatment in of asthma. This study was aimed to compare the efficacy of three different inhaled corticosteroids ciclesonide, budesonide, and fluticasone in bronchial asthma.
Methods: A total of 30 patients with mild to moderately persistent bronchial asthma was selected as per the NAEPP classification in the expert panel report (EPR) update 2002, NHLBL USA 2003. They were randomly divided into 3 groups of 10 patients each, and they were given 3 different steroid inhalers (ciclesonide or budesonide or fluticasone). Baseline and post-therapy spirometry were performed on day 1 and after 2 months and 6 months of treatment. Data were analyzed using SPSS software.
Results: It was observed that most of the cases (43.3%) were between 26 and 35 years of age with female preponderance (56.6%). Significant symptomatic improvement was observed in all 3 groups. The percentage of improvement in mean peak expiratory flow rate was 17%, 18%, and 18% in ciclesonide, budesonide, and fluticasone group, respectively. The percentage improvement of forced expiratory volume in 1 second (FEV1)/forced vital capacity after bronchodilatation was 18%, 18%, and 19% in ciclesonide, budesonide, and fluticasone group, respectively. The improvement in mean FEV1% predicted was 20%, 19%, and 21% in three groups, respectively.
Conclusion: Steroid therapy along with β2-agonists showed a significant improvement in symptoms. There was no difference among the three different types of steroids.
Metrics
References
Global Strategy for Asthma Management and Prevention; GINA_WR_2006.qxp;7/20/07: 2.
Global Strategy for Asthma Management and Prevention; GINA_WR_2006.qxp;7/20/07: 3.
Available at http://www.who.int/mediacentre/factsheets/fs206/en/. Accessed 17 Jun 2014.
Bousquet J, Bousquet PJ, Godard P, Daures JP. The public health implications of asthma. Bull World Health Organ. 2005;83(7):548-54.
EPR-Update 2002. Expert Panel Report: guidelines for the Diagnosis and Management of Asthma. Update on Selected Topics 2002 (EPR-Update 2002). NIH Publication No. 02 5074. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program; 2003.
O’Connor BJ, Kilfeather S, Cheung D, Kafé H, Blagden MD, Schlösser N, et al. Efficacy and safety of ciclesonide in patients with severe asthma: A 12-week, double-blind, randomized, parallel-group study with long-term (1-year)follow-up. Expert Opin Pharmacother. 2010;11:2791-803.
Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(1):143-78.
Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004;114(1):40-7.
Buhl R, Vinkler I, Magyar P, Györi Z, Rybacki C, Middle MV, et al. Comparable efficacy of ciclesonide once daily versus fluticasone propionate twice daily in asthma. Pulm Pharmacol Ther. 2006;19(6):404-12.
Hoshino M. Comparison of effectiveness in ciclesonide and fluticasone propionate on small airway function in mild asthma. Allergol Int. 2010;59(1):59-66.
Black JL, Oliver BG, Roth M. Molecular mechanisms of combination therapy with inhaled corticosteroids and long-acting beta-agonists. Chest. 2009;136(4):1095-100.
Ulrik CS. Outcome of asthma: longitudinal changes in lung function. Eur Respir J. 1999;13(4):904-18.
Burke C, Power CK, Norris A, Condez A, Schmekel B, Poulter LW. Lung function and immunopathological changes after inhaled corticosteroid therapy in asthma. Eur Respir J. 1992;5(1):73-9.
Auffarth B, Postma DS, de Monchy JG, van der Mark TW, Boorsma M, Koëter GH. Effects of inhaled budesonide on spirometric values, reversibility, airway responsiveness, and cough threshold in smokers with chronic obstructive lung disease. Thorax. 1991;46(5):372-7.
Chiu KC, Chou YL, Hsu JY, Lin MS, Lin CH, Chou PC, et al. Comparison of the efficacy of ciclesonide with that of budesonide in mild to moderate asthma patients after step-down therapy: A randomised parallel-group study. NPJ Prim Care Respir Med 2014;24:14010.