Periodic Treatment Regimens With Inhaled Steroids in Asthma or Chronic Obstructive Pulmonary Disease

Abstract

Objective.\p=m-\To determine whether inhaled corticosteroids can be discontinued in the stable phase of asthma or chronic obstructive pulmonary disease (COPD) or if this therapy should be continued.Design.\p=m-\Nonrandomizedopen uncontrolled 5-year trial. Setting.\p=m-\Prospectivestudy in general practice.Patients.\p=m-\Forty-eightpatients with steroid-dependent asthma or COPD who had shown a decline in forced expiratory volume in 1 second (FEV1) of at least 80 mL per year and at least one exacerbation per year during the first 2 years of bronchodilator treatment. Subjects were treated additionally with inhaled steroids for another 2 years and were finally given the option to stop using steroids. Sixteen patients were willing to stop using beclomethasone and were studied for another year. No recruitment bias took place in this consecutive sample in the fifth year of follow-up. Two of 16 patients developed carcinomas and dropped out.Interventions.\p=m-\Two years of bronchodilator treatment alone (400 \ g=m\ g of salbutamol or 40 \g=m\g of ipratropium bromide four times daily), followed by 2 years of additional inhaled corticosteroid treatment (400 \g=m\g of beclomethasone two times daily), and finally 1 year of bronchodilator treatment alone. Main Outcome Measures.\p=m-\Declinein lung function (FEV1), change in bronchial hyperresponsiveness, indicated by a provocative concentration of histamine causing a 20% fall in FEV1 (PC20), morning peak expiratory flow rate (PEFR), diurnal PEFR, week-to-week variation of PEFR, bronchial symptoms, and exacerbations.Results.\p=m-\Thecourse of FEV1 during the year in which beclomethasone was discontinued was not significantly different when compared with the 2-year period of beclomethasone treatment. Neither did the course of PC20, morning PEFR, diurnal PEFR, symptom score, and exacerbation rate change. Only the week-to\x=req-\ week variation of the PEFR increased after discontinuing steroids.Conclusions.\p=m-\Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.

Inhaled and nasal corticosteroids: safety aspects*

“…Several transcription factors are involved in this mechanism ( 18–24). ICS exert their clinical and anti‐inflammatory actions directly on the bronchial wall; therefore, these effects depend upon a wide range of variables, including the status of the bronchial wall ( 12, 13, 25), the pharmacodynamic‐pharmacokinetic properties of the drug ( 26–30), the delivery system ( 31–34), the patient's cooperation ( 35–38), and the dosage regimen ( 39–41). These factors also determine the severity and frequency of side‐effects.…”

Global strategies for reducing the burden from asthma

“…[8][9][10][11] This finding was especially important for primary care as bronchodilators were until then often used as the sole medication for asthma in general practice. It stimulated efforts to ensure the early introduction of inhaled steroids in asthma as well as the use of combination drugs (inhaled long-acting bronchodilators together with corticosteroids in one device), which are nowadays the mainstay of asthma treatment both in primary and secondary care.…”

New treatment options in allergic rhinitis: patient considerations and the role of ciclesonide

“…Several transcription factors are involved in this mechanism (CarsonJurica et al 1990;Munk et al 1990;Funder 1993;Barnes and Adcock 1993;Smith and Toft 1993;Barnes 1996). ICS exert their clinical and anti-infl ammatory actions depending on a wide range of variables, including the status of the nasal and bronchial wall (Laitinen 1994;Barnes 1995;Kraft et al 1996), the pharmacodynamic-pharmacokinetic properties of the drug (Andersson and Ryrfeldt 1984;English et al 1994;Miller-Larson et al 1994;Lipworth 1995;Johnson 1996), the delivery system (Brown et al 1990;Selroos and Halme 1991;Smith et al 1995;Pedersen 1996), the patient's cooperation (Toogood et al 1984;Pedersen et al 1986;Lindgren et al 1987;Newman et al 1991), and the dosage regimen (Munch et al 1982;Pincus et al 1995;van Schayck et al 1995;Bernstein et al 2004). These factors also determine the severity and frequency of side-effects (Passalacqua et al 2000).…”