Steroid Aerosols in Asthma: An Assessment of Betamethasone Valerate and a 12-month Study of Patients on Maintenance Treatment

Abstract

SummaryBetamethasone valerate aerosol is a new compound for the treatment of asthma. Its clinical effectiveness was established in a double-blind cross-over trial in nonsteroid-dependent asthmatic patients. At a dosage of 400 to 800 tsg/day for three months there was no evidence of suppression of hypothalamic-pituitary-adrenal function, as assessed by tetracosactrin and insulin stress tests.A 12-month follow-up study of 120 patients using steroid aerosols (betamethasone valerate or beclomethasone dipropionate) indicated that tolerance does not develop and that a daily maintenance dose of 200 tsg/day was adequate in most patients. Temporary lack of response was observed during episodes of sputum production or of heavy exposure to antigen.There were no observed side effects other than fungal infections of the respiratory tract. However, the incidence of candidiasis ofthe pharynx (13%) and particularly of the larynx (5%) in apparently immunologically normal patients was disturbing. These infections were not seen in pauents taking 200 ,ug/day. Though there is yet no eviaence that fungal infections associated with steroid aerosols may penetrate the trachea and bronchi the possibility of this indicates that caution should be exercised in their use, particularly in long-term high dosage.

Effect of placebo substitution during long-term betamethasone valerate aerosol treatment in asthmatic children.

“…Recent studies have shown the effectiveness of betamethasone valerate aerosol in the prophylactic therapy of severe childhood asthma (Frears, Wilson, and Friedman, 1973;McAllen, Kochanowski, and Shaw, 1974). These findings are comparable with those shown in children using a different inhaled steroid with high topical activity, beclomethasone dipropionate (Dickson et al, 1973;Morrow Brown and Storey, 1973).…”

An Open Assessment of Becotide® (Beclomethasone Dipropionate) Nasal Spray in Seasonal Allergic Rhinitis

“…Inhaled beclomethasone dipropionate is beneficial in the treatment of bronchial asthma in doses that do not affect adrenal function (i, 2,4,7,9,12,13,16). It is also effective in patients with hay fever in an intranasal dose of 400 ng/day without producing evident adrenal suppression; this is according to Mygind (15), who registered a lower, but not significantly lower, mean value of 17-ketogenic steroids in urine during the beclomethasone treatment period than in the period of placebo treatment.…”

“…The risk of superinfection is obviously dose-dependent (13), and in the administered dosage of beclomethasone dipropionate-less than 400 ;ug/24 hours-the risk is considerably reduced. Long-term treatment with beclomethasone dipropionate in cases of bronchial asthma has proved to involve an increased risk especially of fungal infection-in the first place, Candida albicans (14).…”

Nanotechnology and pulmonary delivery to overcome resistance in infectious diseases

“…Despite inhalation being started as a route to treat diseases constrained to the respiratory tract, with scientific and technological advances, a change in paradigm took place and over the years, inhalation has been clinically evaluated and used to treat both local and systemic diseases [8] such as asthma [9], TB [10] and other bacterial infections [11], influenza virus infection [12], fungal infections [13], cystic fibrosis [14], chronic obstructive pulmonary disease [15], diabetes [16] or cancer [17,18]. Moreover, inhalation has been also tested as a non-invasive vaccination platform [19,20].…”