High or standard initial dose of budesonide to control mild-to-moderate asthma?

Chanez, Pascal; Karlstrom, Rolf O.; Godard, P

doi:10.1183/09031936.01.17508560

Cited by 21 publications

(19 citation statements)

References 21 publications

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“…The findings are also consistent with other dose-response studies of budesonide that did not include a placebo arm and as a result could not be included in this meta-analysis [21][22][23][24][25][26][27][28]. For example, similar results were found in the studies by CHANEZ et al [22] and TUKIAINEN et al [23], which showed no difference between initial treatment with 400 or 1,600 mg?day -1 budesonide after 4 weeks, or with 200 or 800 mg?day -1 after 12 weeks, respectively.…”

Section: Key Findingssupporting

confidence: 85%

“…For example, similar results were found in the studies by CHANEZ et al [22] and TUKIAINEN et al [23], which showed no difference between initial treatment with 400 or 1,600 mg?day -1 budesonide after 4 weeks, or with 200 or 800 mg?day -1 after 12 weeks, respectively. In the FACET study [25], there were clinically significant improvements in asthma control with budesonide taken over a 12-month period at 800 as compared to 200 mg?day -1 .…”

Section: Key Findingssupporting

confidence: 84%

“…However, this was not the case, as only two nonplacebo-controlled studies identified examined doses of w800 mg?day -1 [21,22] and these studies indicated that there was a minimal additional benefit of using doses up to 3,200 mg?day -1 . For reasons stated previously, the authors were unable to undertake a meaningful statistical analysis of withdrawals due to worsening asthma.…”

Section: Limitations Of the Studymentioning

confidence: 99%

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Dose-response relationship of inhaled budesonide in adult asthma: a meta-analysis

Masoli

Holt²,

Weatherall³

et al. 2004

European Respiratory Journal

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The aim of this study was to examine the dose-response relationship of inhaled budesonide in adolescents and adults with asthma.A meta-analysis was carried out on placebo-controlled, randomised clinical trials, presenting data on at least one outcome measure of asthma and using at least two doses of budesonide, delivered by turbuhaler or metered-dose inhalerzspacer twice daily.A total of six studies of 1,435 adolescents and adults, with mild to moderately severe asthma, met the inclusion criteria for the meta-analysis. A negative exponential model indicated that 80% of the benefit at 1,600 mg?day -1 was achieved at doses of y200-400 mg?day -1 and 90% by 300-600 mg?day -1 . Meta-regression with a quadratic term in dose showed that the maximum effect was obtained with doses of y1,000 mg?day -1 . In conclusion, the available published data indicate that, in adolescents and adults with mild to moderate asthma, most of the therapeutic benefit of budesonide delivered by turbuhaler or metered-dose inhalerzspacer is achieved with a dose of y400 mg?day -1 and the maximum effect is achieved at y1,000 mg?day -1 . This conclusion is qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids and that the subjects included in this meta-analysis had predominantly mild to moderate asthma. In a recent meta-analysis of the dose-response relationship of fluticasone, it was shown that most of the therapeutic benefit is achieved with doses of 100-250 mg?day -1 , and that the maximum effect is obtained at y500 mg?day -1 in adolescents and adults with asthma [1]. This therapeutic dose range is two-fold lower than that recommended in the international and national consensus guidelines and formularies, and the dose commonly prescribed in clinical practice [2][3][4]. In view of this disparity and in response to the recommendations of the Cochrane Centre [5], the current authors have further investigated the therapeutic dose range of inhaled corticosteroids by undertaking a similar meta-analysis of the doseresponse relationship of budesonide. MethodsA search of Medline was conducted from Jan 1966 to Jan 2003 and of Embase from Jan 1980 to Jan 2003. On Medline, studies were searched using a combination of the keywords "budesonide" and "dose" or "dosage". AstraZeneca, the manufacturer of budesonide, was also asked for details of all relevant studies; no additional studies were identified. No relevant studies published in other languages were found on Medline or Embase. Finally, the reference lists of relevant studies were examined and no other studies were found. Inclusion criteriaTwo people examined each paper9s title and abstract, and then the full paper if necessary. To be included in the primary meta-analysis, studies had to meet all of the following criteria: a double-blind, placebo-controlled, randomised trial involving two or more doses of budesonide, delivered by turbuhaler or metered-dose inhaler (MDI)zspacer device twice daily, in adolescents (agedw12 yrs) or...

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Section: Key Findingssupporting

confidence: 85%

Section: Key Findingssupporting

confidence: 84%

Section: Limitations Of the Studymentioning

confidence: 99%

See 1 more Smart Citation

Dose-response relationship of inhaled budesonide in adult asthma: a meta-analysis

Masoli

Holt²,

Weatherall³

et al. 2004

European Respiratory Journal

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“…A dose of beclomethasone (200 mg twice daily) that is within the recommended starting-dose range (200-500 mg) of the Global Initiative for Asthma guidelines was chosen [11]. In addition, CHANEZ et al [23] showed that both high (800 mg) and standard (200 mg) initial doses of budesonide were equally effective in controlling symptoms and improving lung function in mildto-moderate asthma. The dose of montelukast is the labelled dose for adults (10 mg once daily), as established in dose-ranging studies [24,25,26].…”

Section: Discussionmentioning

confidence: 99%

Distribution of therapeutic response in asthma control between oral montelukast and inhaled beclomethasone

Baumgartner

Martínez²,

Edelman³

et al. 2003

Eur Respir J

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The distribution of responses in study populations provides a novel method of comparing the benefit of two treatments. This 6-week, randomised, placebocontrolled, double-blind study compared the effectiveness of oral montelukast with inhaled beclomethasone in chronic asthma by assessing the distribution and overlap of patient responses to therapy, as measured by a clinical outcome (asthma control days).A total of 730 adult patients with asthma, age 15-65 yrs, with a forced expiratory volume in one second (FEV1) at baseline of 50-85% of predicted and o15% improvement in FEV1 after inhaled b-agonist were enrolled. After a 2-week placebo run-in period, patients were randomly allocated to receive montelukast (10 mg once daily), inhaled beclomethasone (200 mg twice daily) or placebo. The primary end-point (per cent of asthma control days) was compared between treatments as the overlap in the response distributions.The overlap of the distribution of responses between the montelukast and beclomethasone groups was 89% for per cent asthma control days and 96% for change from baseline in FEV1. The mean (¡SD) per cent asthma control days in the montelukast and beclomethasone groups was significantly higher than that in the placebo group (placebo 40.0 ¡ 35.8, montelukast 50.7 ¡ 37.1, beclomethasone 57.9 ¡ 36.1). The mean differences between montelukast and placebo, beclomethasone and placebo, and montelukast and beclomethasone were significant. The mean per cent change (¡SD) from baseline in FEV1 was 12.1¡18.7 and 13.9¡20.8 in the montelukast and beclomethasone groups, respectively, and significantly greater than that in the placebo group (6.4¡20.1); there was no significant difference between the montelukast and beclomethasone groups in mean values or response distribution. There was also no difference among treatment groups in the frequency of adverse experiences.A comparison of the response distribution is an important approach to comparing therapies; montelukast and beclomethasone provided similar response distributions for the end-point of per cent asthma control days over a 6-week treatment period. Eur Respir J 2003; 21: 123-128

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“…ICS and ICS/ LABA are used as a first choice for asthma treatment around the world. The effectiveness of ICS and ICS/LABA for asthma treatment is supported in plural large clinical trials [21][22][23][24][25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Diaphragm Muscle Contraction Decrease in a Mouse Model of Ovalbumin-Induced Allergic Airway Inflammation

Yamaguchi¹,

Shindoh²,

Miura³

2017

J Allergy Ther

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Objective: We investigated diaphragm contractile and inflammatory properties of mice with OVA sensitization and challenge.Methods: BALB/c mice were sensitized to OVA by intraperitoneal (i.p.) injection at 0 and 7 days, and challenged with aerosolized OVA on 21, 22, and 23 days (O/O group). Budesonide/Formoterol combination was inhaled on days 21, 22, and 23 before OVA challenge on those same days (O/OC group). Control mice were sensitized and challenged with an aerosolized saline (O-group). The diaphragm contractile and inflammatory properties were measured on day 24. NOS activity in the diaphragm muscle was evaluated by NADPH diaphorase staining. IL-4 and IL-13 levels of BALF, as well as lung tissue and diaphragm muscle homogenates were measured by ELISA. Conclusions:OVA sensitization and challenge decreased diaphragm muscle contraction, increased NOS activity, IL-4 levels of diaphragm in a mouse model. Budesonide/Formoterol combination could protect diaphragm muscle weakness and inflammation. According to the traditional concept of the contemporary Immunology, neither autoimmune diseases nor allergic diseases can be cured completely. Nevertheless, a fortunate coincidence led me to discovery of a novel concept that eliminations of the causes of these diseases are possible. In other words, combinations of pathogenic antibodies with responsible cells, namely, cytolytic T lymphocytes in cases of autoimmune diseases and mast cells in cases of allergic diseases, can be decomposed by replacing the pathogenic antibodies with non-specific antibodies. In more detail, intradermal injections with a non-specific antigen preparation induce production of non-specific antibodies in the body of the patient. Repetitions of the injections bring about an accumulation of them. Accumulated non-specific antibodies will occupy most of the receptors on the surface of responsible cells. When the accumulation reaches the sufficient level, virtually no pathogenic antibodies would remain on the receptors. That is, no causes of the diseases remain. Naturally, where there is no cause, there is no disease. Details are demonstrated elsewhere.

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High or standard initial dose of budesonide to control mild-to-moderate asthma?

Cited by 21 publications

References 21 publications

Dose-response relationship of inhaled budesonide in adult asthma: a meta-analysis

Dose-response relationship of inhaled budesonide in adult asthma: a meta-analysis

Distribution of therapeutic response in asthma control between oral montelukast and inhaled beclomethasone

Diaphragm Muscle Contraction Decrease in a Mouse Model of Ovalbumin-Induced Allergic Airway Inflammation

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