Inhaled versus oral steroids for adults with chronic asthma

Objectives To determine therapeutically equivalent doses of inhaled versus oral steroids for adults with chronic asthma. Search strategy The Cochrane Airways Group trials register was searched using the terms: (drug delivery systems OR ((nebuli* OR inhal* OR MDI) AND oral*)) AND ( steroid* OR corticosteroid* OR glucocorticoid* OR beclomethasone OR betamethasone OR fluticasone OR cortisone OR dexamethasone OR hydrocortisone OR prednisolone OR prednisone OR triamcinolone). Selection criteria Randomised controlled trials were selected of at least 4 weeks duration and included patients over the age of 15 years with chronic asthma. Trials compared inhaled steroids and oral prednisolone or prednisone; where the maximum dose for inhaled steroids was 2000 mcg/day and prednisolone 60 mg (on alternate days). Data collection and analysis Two independent reviewers screened 1285 titles and abstracts from the electronic search, bibliography searches and other contacts. Of these, 10 trials met previously defined inclusion criteria. Two reviewers independently extracted study characteristics, and outcome measures. Main results All trials were small and no data could be pooled. Carry-over effects were present in at least one cross-over trial. Data from six trials produced the same pattern, in which prednisolone 7.5-12 mg/day appeared to be as effective as inhaled steroid 300-2000 mcg/day. In two trials, inhaled steroid 300-400 mcg/day was more effective than prednisolone 5 mg/day. All doses of inhaled steroid appeared to be more effective than alternate day doses of prednisolone up to 60 mg on alternate days. Side-effect data were reported too variably to permit comparisons. A 30% incidence was reported in one study in patients receiving prednisolone 5 mg/day, none were reported in patients on inhaled steroids. Reviewer's conclusions A daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Side-effects may be present on low doses, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed.

[1]  P. Sharek,et al.  Beclomethasone for asthma in children: effects on linear growth. , 1999, The Cochrane database of systematic reviews.

[2]  P. Paré,et al.  A randomized, controlled trial of high dose, inhaled budesonide versus oral prednisone in patients discharged from the emergency department following an acute asthma exacerbation. , 2000, Canadian respiratory journal.

[3]  D. Postma,et al.  Effects of inhaled fluticasone and oral prednisolone on clinical and inflammatory parameters in patients with asthma , 1999, Thorax.

[4]  J. Walters,et al.  Many reports of RCTs give insufficient data for Cochrane reviewers , 1999, BMJ.

[5]  Heather Eliassen,et al.  The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group. , 1999, Controlled clinical trials.

[6]  A. Ebbutt,et al.  Practical issues in equivalence trials. , 1998, Statistics in medicine.

[7]  J A Lewis,et al.  Trials to assess equivalence: the importance of rigorous methods , 1996, BMJ.

[8]  R. Soda,et al.  [Usefulness of inhaled steroids in steroid-dependent intractable asthma--equivalent dose of oral steroid to inhaled steroid]. , 1994, Arerugi = [Allergy].

[9]  J. J. Tamminga,et al.  Comparison of inhaled beclomethasone dipropionate 1000 micrograms twice daily and oral prednisone 10 mg once daily in asthmatic patients. , 1994, Thorax.

[10]  D. Postma,et al.  Separate and combined effects of corticosteroids and bronchodilators on airflow obstruction and airway hyperresponsiveness in asthma. , 1992, The Journal of allergy and clinical immunology.

[11]  T. Wagner,et al.  First-time treatment with steroids in bronchial asthma: comparison of the effects of inhaled beclomethasone and of oral prednisone on airway function, bronchial reactivity and hypothalamic-pituitary-adrenal axis. , 1990, The European respiratory journal.

[12]  J. Baskerville,et al.  Bioequivalent doses of budesonide and prednisone in moderate and severe asthma. , 1989, The Journal of allergy and clinical immunology.

[13]  P. Bamberg,et al.  Comparison of inhaled budesonide with oral prednisolone at two dose-levels commonly used for the treatment of moderate asthma. , 1989, The European respiratory journal.

[14]  C. Jenkins,et al.  Effect of prednisone and beclomethasone dipropionate on airway responsiveness in asthma: a comparative study. , 1988, Thorax.

[15]  J. Toogood.  Efficiency of inhaled versus oral steroid treatment of chronic asthma. , 1987, New England and regional allergy proceedings.

[16]  P. Tothill,et al.  Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica. , 1986, British medical journal.

[17]  J. Baskerville,et al.  Use of spacers to facilitate inhaled corticosteroid treatment of asthma. , 2015, The American review of respiratory disease.

[18]  J. Baskerville,et al.  Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid, budesonide. , 1982, The Journal of allergy and clinical immunology.

[19]  L. Rosenhall,et al.  Comparison between inhaled and oral corticosteroids in patients with chronic asthma. , 1982, European journal of respiratory diseases. Supplement.

[20]  I. Grant,et al.  Beclomethasone dipropionate aerosol in treatment of chronic asthma. , 1977, British journal of clinical pharmacology.

[21]  J. Chopra,et al.  Double blind cross over trial of beclamethasone dipripionate aerosol and oral prednisolone in bronchial asthma. , 1976, The Journal of the Association of Physicians of India.

[22]  N. Eriksson,et al.  A double-blind comparison of beclomethasone dipropionate aerosol and prednisolone in asthmatic patients. , 1975, Postgraduate medical journal.

[23]  A. Busuttil,et al.  POLYPLOIDAL GIANT CELLS IN A LARYNGEAL BIOPSY , 1974 .

[24]  K. Alanko,et al.  A comparative study of the efficacy of inhaled beclomethasone and systemic prednisolone in bronchial asthma. , 1974, Scandinavian journal of respiratory diseases.

[25]  S Lal,et al.  Comparison of Beclomethasone Dipropionate Aerosol and Prednisolone in Reversible Airways Obstruction , 1972, British medical journal.

[26]  H. Smyllie,et al.  Incidence of serious complications of corticosteroid therapy in respiratory disease. A retrospective survey of patients in the Brompton hospital. , 1968, Thorax.