New data suggests that one of two inhaled asthma therapies is at least as effective as the other despite being prescribed at a much lower dose, according to data from a recent comparative study1.
A research team led by the 黑料网 compared the inhaled corticosteroids fluticasone and extra-fine hydrofluoroalkane beclometasone (hereafter referred to as beclometasone), both commonly prescribed as asthma 鈥榩reventer鈥� therapy.
Using the UK General Practice Research Database2, the team studied the medical records of more than 1,500 patients aged five to 60 over a two-year period. The patients had all been prescribed one of the two steroids, usually taken twice a day through an inhaler to ease and prevent asthma symptoms and attacks.
The researchers 鈥� whose findings appear today in the Journal of Allergy and Clinical Immunology 鈥� looked at patients who were prescribed inhaled steroids for the first time and at patients who had their steroid dose increased.
Both drugs improved asthma control substantially, however, Professor David Price, Professor of Primary Care Respiratory Medicine at the 黑料网, said that one of the two steroids appeared to offer additional benefits.
鈥淥ur study showed that patients prescribed HFA beclometasone had a similar, or in some cases better, chance of achieving asthma control at a lower prescribed steroid dose than patients prescribed fluticasone. Fluticasone is a highly effective inhaled steroid and should be prescribed at the same dose as HFA beclometasone, yet often appears to be prescribed at a higher dose in routine clinical practice.
鈥淭he finding may be explained by formulation differences between the two steroids. HFA beclometasone has smaller sized particles than fluticasone, which may result in better distribution of the steroid throughout the entire lung rather than just targeting the large airways.
鈥淭his may mean that patients who don鈥檛 use their inhalers properly 鈥� and many people have poor inhaler technique 鈥� can get away with it because the smaller particles still seem to get down into the lung.
鈥淥ur study seems to show that both targeting the smaller airways of the lung and particle size may play important roles in the effectiveness of steroid treatment in asthma patients. However more studies are now needed.
鈥淎sthma patients whose conditions are being controlled by their treatment should not look to change their inhaler, although their clinician may consider reducing their dose.鈥�
The research team say a long-term comparative study of inhaled corticosteroids was needed to establish the effectiveness of using different drugs in asthma patients. Their comparison focused on the presence/absence of asthma control and the number and frequency of any asthma flare-ups experienced by the patient.
鈥淎sthma management guidelines recommend long-term treatment with inhaled corticosteroids to alleviate the chronic airway inflammation present in persistent asthma,鈥� said Professor Price.
鈥淏ecause research studies have not yet identified significant differences in clinical effectiveness among available inhalers, a clinician鈥檚 choice of inhaler is often guided by convenience and cost rather than by effectiveness.
鈥淥ur findings support guideline recommendations for initiating steroid inhalers, and increasing the dose as necessary, to manage persistent asthma before adding additional types of therapy.鈥�
The researchers explain that their study was different to many other asthma studies, which are usually conducted in specific patient groups. For example, traditional studies often only involve patients with no other medical conditions and who are adept at using their inhalers, and frequently exclude patients with a certain level of lung impairment, which results in poor representation of a substantial proportion of the true asthma population.
Professor Price added: 鈥淚t has been estimated that over 90% of patients seen by GPs would not qualify for typical asthma trials.
鈥淥ur study was a 鈥榬eal-life population study鈥� that looked at data from asthma patients treated in everyday clinical practice, which is quite different to the patient population used in a standard asthma clinical trial.鈥�