Inhaled beclomethasone dipropionate...

Inhaled beclomethasone dipropionate has been an effective long-term asthma treatment for more than 40 years. Traditional delivery is by the agency of pressurized metered-dose inhaler using a chlorofluorocarbon propellant. Beclomethasone dipropionate lately has been reformulated into a solution, rather than a suspension, with hydrofluoroalkane-134a used as the propellant. Consequently the corticosteroid can be delivered as an extra-fine aerosol with a great deal of smaller particle size that allows better delivery of the medication into the smaller airways. The recently made known formulation also reduces systemic absorption of beclomethasone dipropionate, thereby lessening the risk of systemic adverse general intents such as short-term growth retardation, adrenal suppression, and bone los or decreased bone mineral density. Nayak and associates studied the safety and efficacy of the fresh delivery system for inhaled beclomethasone dipropionate in children with moderate asthma. They also evaluated the effectiveness of a lower dosage of extra-fine beclomethasone dipropionate in controlling asthma.

The trial was a multicenter, randomized, double-blind, placebo-controlled, parallel-group hospital outpatient meditation of children with asthma. Children five to 12 years of age with stable, moderate, symptomatic asthma were guarded for inclusion in the meditation All of the children were receiving a short-acting beta agonist as needinessed A total of 353 children were randomized to receive extra-fine aerosolized beclomethasone dipropionate in a dosage of 40 or 80 mcg twice daily, or placebo. The trial lasted 12 weeks, with assessment of lung function, adverse incidents and diary cards every sum of two units weeks.

Compared with the placebo cluster both treatment groups had a significant, dosage-dependent improvement in lung function as measured at forced expiratory volume at united second (FE[V.sub.1]). There was also a significant decrease in daily beta-agonist use, an improvement in peak expiratory come and an increase in the percentage of symptom-free days. The number and model of adverse events were similar among the three assign places tos and there was no significant difference in morning cortisol on a levels among the groups at the fall of the curtain of the trial.

The authors infer that extra-fine aerosolized beclomethasone dipropionate in a dosage of 80 to 160 mcg by day is a safe and effective treatment option for moderate asthma in children. They add that improved lung deposition of the medication allows the use of lower dosages compared with those required for chlorofluorocarbon-beclomethasone dipropionate, and that use of lower dosages may make the potential for systemic adverse events

KARL E MILLER, MD

Nayak A, et al. Efficacy and safety of beclomethasone dipropionate extrafine aerosol in childhood asthma. A 12-week, randomized, double-blind, placebo-controlled consideration Chest December 2002;122:1956-65.

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