Inpharma 1070 - 18 Jan 1997

Systemic or inhaledcorticosteroids for acute asthmaInhaled and systemic corticosteroids appear to have

similar efficacy for acute exacerbations of asthma thatdo not require hospitalisation, report researchers in theUK.1 In their study, the efficacy of inhaled fluticasone 2mg/day was compared with a tapered dose ofprednisolone (initial dose 40 mg/day, reduced by 5mg/day every other day) in patients with moderateexacerbations of asthma.

Similar proportion of treatment successesOf the 413 patients randomised, 200 fluticasone and

203 prednisolone recipients were evaluable; 54 (27%)and 46 (22.7%) patients, respectively, were classified astreatment failures*, and 96 and 98 patients, respectively,(48%) in each treatment group were classified astreatment successes.**

25% of fluticasone recipients and 29% of prednisolonerecipients did not meet criteria for either treatmentfailure or success.

A change to recommended therapy?Does this mean a change to recommended therapy?

Not according to Dr Chris Griffiths of the MedicalCollege of Bartholomew and the Royal London Hospital.Commenting on the above study, Dr Griffiths notes thatthe study was well conducted and innovative, buthighlights that the tapered prednisolone dose used wasnot a ‘gold standard’ comparator.2 A larger prednisolonedose, which was not tapered, would have been moreappropriate for comparison, he says.

Avoiding the use of systemic corticosteroids isdesirable, and the superior safety profile of inhaledcompared with systemic corticosteroids has been wellestablished. However, whether clinically significantadverse effects will result from the occasional use ofsystemic corticosteroid is not so clear, notes DrGriffiths.

Fluticasone expensive vs prednisoloneTwo weeks of inhaled fluticasone in this context costs

approximately 70 times as much as a course of oralprednisolone, Dr Griffiths points out. With littledifference in efficacy between the drugs and the safetyconcerns still to be resolved, the cost implications forthe National Health Service and for general practitionersare not trivial, he says.

The study provides ‘a promising start’ for investigationof the benefits of high-dose inhaled corticosteroids inpatients with exacerbations of asthma, but ‘furtherstudies are needed’ before any changes torecommended treatment are promoted, concludes DrGriffiths.* Treatment failure was defined as a reduction in PEFR to < 60% ofpredicted values on 2 consecutive occasions, or persistent symptomswith no improvement on 3 consecutive days.** Treatment success was defined as an increase in percentage ofpredicted morning PEFR of ≥ 10%.

1. Levy ML, et al. Comparison of short courses of oral prednisolone andfluticasone propionate in the treatment of adults with acute exacerbations ofasthma in primary care. Thorax 51: 1087-1092, Nov 1996.

2. Griffiths C. Steroids in exacerbations of asthma: tablets or inhalers? Thorax 51:1071-1072, Nov 1996.

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Inpharma 18 Jan 1997 No. 10701173-8324/10/1070-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved