A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma

doi:10.1016/0091-6749(77)90051-3

Journal of Allergy and Clinical Immunology

Volume 59, Issue 4, April 1977, Pages 298-308

https://doi.org/10.1016/0091-6749(77)90051-3 Get rights and content

Abstract

In a 26-wk double-blind controlled study of 34 patients whose asthma had been poorly controlled despite oral steroids, valuable clinical and pulmonary function improvement was derived by adding beclomethasone aerosol to the prednisone regimen. The amount of improvement correlated linearly with beclomethasone dosage over the range 200 to 1,600 μg/day. These patients required relatively high dosage. Success in achieving asymptomatic status was only 26% with the conventional 400 μg/day and 60% at 1,600 μg/day. Oropharyngeal candidiasis was also dose-related but did not prohibit the use of high-dosage beclomethasone. Respiratiory infections, physical signs, blood glucose, and electrolytes were unaffected by the drug. A dose-related suppression of cortisol secretion was demonstrated, but about $14$ of the group had normal plasma cortisol even at 1,600 μg/day plus the oral prednisone. An individualized risk-benefit assessment seems a better basis for choosing an optimal beclomethasone regimen for each patient than adherence to a conventionalized fixed dosage of 400 μg/day. This requires definition of: (1) a specific goal of treatment in the individual patient and the beclomethasone dosage required to achieve it; (2) the adrenocortical functional response of that particular patient to the desired dose of beclomethasone; and (3) the presence and degree of any dose-limiting constraints such as preexisting complications of steroid use.

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Therefore a Boxed Warning stating this will remain in the labels of all single-ingredient LABA medicines which are approved to treat asthma….” A new steroid, beclomethasone diproprionate (BDP), was developed for inhalation and patented in 1962, became commercially available in 1972 [70, 71] and was widely used as daily therapy both in children [72] and adults [73] and remains so to-day. The move to using an inhaled steroid was likely hastened by the finding that BDP, as an aerosol in a dose of 400–800 μg per day, enabled a reduction in dose of oral prednisolone in patients with chronic, severe, steroid-dependent asthma [74].
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^☆: Supported by grants from Schering (Canada) Ltd., the Medical Associates of Victoria Hospital, the Ontario Respiratory Disease Foundation, and the London-Middlesex Christmas Seals Undergraduate Research Fellowship Fund.

View full text

A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma☆

Abstract

Lancet

Pediatr. Clin. North Am

Br. J. Dis. Chest

J. Steroid Biochem

Chest

Comput. Biomed. Res

J. Allergy Clin. Immunol

Br. J. Anaesth

J. Pediatr

Beclomethasone Dipropionate: A new steroid aerosol for the treatment of allergic asthma

Br. Med. J

Beclomethasone aerosol in childhood asthma

Arch. Dis. Child

Recovery of adrenal function after substitution of beclomethasone dipropiona for oral corticosteroids

Br. Med. J

Adrenal failure in bronchial asthma

Br. Med. J

Beclomethasone dipropionate steroid aerosol in treatment of perennial allergic asthma in children

Br. Med. J

Substitution of beclomethasone aerosol for oral prednisolone in the treatment of chronic asthma

Br. Med. J

Double-blind trial comparing two dosage schedules of beclomethasone dipropionate aerosol in the treatment of chronic bronchial asthma

Lancet

Local and systemic effects of beclomethasone inhalation in steroid-dependent asthmatic patients

Curr. Ther. Res

Beclomethasone dipropionate in asthma

Can. Med. Assoc. J

Response of steroid dependent asthmatics to inhaled beclomethasone dipropionate

Ann. R. Coll. Phys. Surg. Can

Trial of a new inhalational steroid preparation in the treatment of steroid-dependent chronic asthmatics

Med. J. Aust

A controlled trial of inhaled corticosteroids in patients receiving prednisone tablets for asthma

Br. J. Dis. Chest

Inhaled corticosteroids compared with oral prednisone in patients starting long-term corticosteroid therapy for asthma

Lancet

Long-term treatment of steroid dependent asthmatic patients with beclomethasone dipropionate

Allergol. Immunopathol

A 1 year follow-up of children and adolescents receiving regular beclomethasone dipropionate

Clin. Allergy

Steroid aerosols in asthma: An assessment of beclomethasone valerate and a 12-month study of patients on maintenance treatment

Br. Med. J

Treatment of childhood asthma for 13 months and longer with beclomethasone dipropionate aerosol

Arch. Dis. Child

Beclomethasone dipropionate: An aerosol corti-costeroid for topical use in bronchial asthma

Postgrad. Med. J