Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid, budesonide

Toogood, J.H.; Baskerville, J.; Jennings, Barbara; Lefcoe, Neville M.; Johansson, Sofia

doi:10.1016/0091-6749(82)90065-3

Cited by 147 publications

(56 citation statements)

References 26 publications

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“…At medium and high doses, twicedaily dosing is necessary for most but not all inhaled glucocorticosteroids (Evidence A) [301]. With budesonide, efficacy may be improved with more frequent dosing (four times daily; Evidence B) [302].…”

Section: Treatment Steps For Achieving Controlmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2008

European Respiratory Journal

2,643

2,301

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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

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Section: Treatment Steps For Achieving Controlmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2008

European Respiratory Journal

2,643

2,301

View full text Add to dashboard Cite

show abstract

“…Administration twice daily is equally effective, 46 although a schedule of four doses per day may be preferable for patients with more severe asthma. 47,48 For patients with mild asthma, one dose per day may suffice. 49 …”

Section: F Requency Of a Dministrationmentioning

confidence: 99%

Inhaled Glucocorticoids for Asthma

Barnes¹

1995

N Engl J Med

584

288

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“…Initially, inhaled steroids were recommended to be used four-times a day. Although such a regimen might be more effective than twice-daily dosing [2], in daily life higher compliance with a twicedaily regimen might well compensate reduced efficacy [3]. Meanwhile numerous studies have shown that in the majority of patients a twice-daily schedule can effectively control asthma and this is presently the standard scheme.…”

mentioning

confidence: 99%

Treatment of asthma by the inhaled corticosteroid ciclesonide given either in the morning or evening

et al. 2001

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The study addressed the question whether the novel inhaled prodrug corticosteroid ciclesonide is equally effective when inhaled in the morning compared to the evening.For this purpose a double-blind, randomized, parallel group study was initiated in which 209 asthmatic patients (forced expiratory volume in one second~50 -90% predicted) inhaled either 200 mg ciclesonide in the morning or in the evening, for 8 weeks. Efficacy was assessed by means of spirometry as well as daily recordings of morning and evening peak expiratory flow (PEF), symptoms and use of rescue medication. The 24-h urinary cortisol excretion was measured to evaluate any effect on hypothalamic-pituitary-adrenol axis.Ciclesonide significantly improved asthma control. Morning and evening administration was shown to be equally effective for the different spirometry variables, evening PEF, symptoms, use of rescue medication and number of asthma exacerbations. Regarding morning PEF, the improvements after evening dosing were more prominent and equivalence of morning and evening administration could not be demonstrated. No relevant influence on cortisol excretion was found.Overall, the study indicates that ciclesonide can be given either in the morning or in the evening to meet the patients9 preference and individual medical needs, although evening administration may lead to a more pronounced improvement in morning peak expiratory flow. Eur Respir J 2001; 17: 1083-1088. The study was supported by Byk Gulden Pharmaceuticals.Inhaled corticosteroids have become the mainstay of therapy for patients with asthma. However, as with other inhaled or oral asthma drugs, compliance to inhaled steroids is often poor [1]. Among the manifold reasons underlying noncompliance, complicated regimens and dosing frequency are considered to be significant factors. Initially, inhaled steroids were recommended to be used four-times a day. Although such a regimen might be more effective than twice-daily dosing [2], in daily life higher compliance with a twicedaily regimen might well compensate reduced efficacy [3]. Meanwhile numerous studies have shown that in the majority of patients a twice-daily schedule can effectively control asthma and this is presently the standard scheme. Additionally, it was suggested that decreasing the dosing frequency to once daily might further enhance adherence to the prescribed regimen [4]. In the past the efficacy of once-daily administration was, therefore, tested with a number of inhaled steroids in patients with mild-to-moderate asthma [5].Ciclesonide is a novel prodrug glucocorticosteroid in development for the treatment of asthma. Ciclesonide which has a chiral centre in the acetal side chain, exists as two epimers with different receptor affinities and metabolization rates. Only R-ciclesonide was selected for clinical development (referred to as ciclesonide from now on). Ciclesonide itself is inactive and needs to be cleaved by esterases to bind to the glucocorticoid receptor. The efficacy of ciclesonide in humans was demonstr...

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Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid, budesonide

Cited by 147 publications

References 26 publications

Global strategy for asthma management and prevention: GINA executive summary

Global strategy for asthma management and prevention: GINA executive summary

Inhaled Glucocorticoids for Asthma

Treatment of asthma by the inhaled corticosteroid ciclesonide given either in the morning or evening

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