Page 30 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 30
evidence of adrenal suppression. In other twice daily regimen.51,52 Ciclesonide is a prod-
studies Beclomethasone dipropionate proved rug glucocorticosteroid which itself is inac-
severe asthma forum 1: severe asthma - basic and clinical views a safe and effective alternative to oral Prednis- tive and needs to be cleaved by esterases in the
olone by means of patients’ preference, use of lung to bind to the glucocorticoid receptor. In
rescue medications and lung function (PEFR, the majority of clinical trials, it was adminis-
FEV1).37,40 tered as a single dose.53–55 Fluticasone Furoate
is the newest discovered inhaled corticosteroid
Budesonide, the second broadly used in- that demonstrates prolonged action up to 26 h
haled ICS, was patented in 1973.41 The first in asthma patients.56
studies on asthmatic patients showed a com-
parable action with beclomethasone in asth- Pilot Studies
ma control in both adults and children.42,43 on Asthma Pathophysiology:
In vivo studies have shown different phar- The Role of Inflammation
macodynamic properties and although be-
clomethasone has higher receptor affini- Understanding the pathophysiology and in-
ty, Budesonide has higher in vitro potency.44 flammatory triggers and processes of asthma
Like Beclomethasone, the introduction of as well as the effects of ICS on the control of
Budesonide in corticosteroid dependent pa- inflammation and bronchial mucosal infiltra-
tients with severe asthma seemed to offer an tion was a milestone in asthma management.
improvement, allowing substantial reduc- Laboratory and clinical studies established in-
tion or withdrawal of oral prednisolone with- haled steroid treatment as the main therapeu-
out systemic absorbsion.45 Fluticasone pro- tic option for asthma, dethroning bronchodi-
pionate was patented in 1980 and approved lator monotherapy. In 1991 Laitinen LA and
for medical use in 1990.46 In a large interna- coworkers compared the effect of budesonide
tional study fluticasone propionate 1mg/day and terbutaline, on clinical symptoms, lung
was as effective as 2mg/day beclomethasone function, and airway epithelium (on biopsies
dipropionate in the control of severe asthma, obtained with bronchoscopy) in 14 adult pa-
better effect on lung function with less effect tients with newly diagnosed asthma. Budes-
on adrenal function.47,48 The results were sim- onide improved lung function and bronchi-
ilar in lower doses of both medications.49 Oth- al hyperreactivity but most importantly was
er studies also demonstrated that both the dry more effective in ameliorating abnormalities
powder and aerosolized formulations of fluti- of the bronchial epithelium and decreasing
casone propionate had twice the efficacy of inflammation in the airways.57 One year ear-
beclomethasone dipropionate via a pressur- lier Haahtela and coworkers had shown that
ized inhaler, introducing an alternative dry early anti-inflammatory treatment with ICS
powder device (Diskhaler) for asthma drug in newly detected asthma resulted in greater
delivery.50 improvement of symptoms and lung function
than treatment with terbutaline and that the
In the last 30 years, three more inhaled improvement lasted through the entire two-
steroid agents were introduced: Mometa- year study period.58 In a follow-up study, pa-
sone Furoate, Ciclesonide, and Fluticasone tients who had been assigned to terbutaline
Furoate. Mometasone furoate is a highly po- were assigned to ICS and experienced less
tent synthetic glucocorticoid initially used improvement than those who had started on
as a topical dermatologic agent proved to ICS, suggesting that early treatment was more
be an effective treatment for patients with effective than delayed treatmen, ie treatment
mild-to-moderate persistent asthma previous- later into the course of asthma.59,60
ly taking only inhaled β2-adrenergic agonists
when administered either as a once daily or
studies Beclomethasone dipropionate proved rug glucocorticosteroid which itself is inac-
severe asthma forum 1: severe asthma - basic and clinical views a safe and effective alternative to oral Prednis- tive and needs to be cleaved by esterases in the
olone by means of patients’ preference, use of lung to bind to the glucocorticoid receptor. In
rescue medications and lung function (PEFR, the majority of clinical trials, it was adminis-
FEV1).37,40 tered as a single dose.53–55 Fluticasone Furoate
is the newest discovered inhaled corticosteroid
Budesonide, the second broadly used in- that demonstrates prolonged action up to 26 h
haled ICS, was patented in 1973.41 The first in asthma patients.56
studies on asthmatic patients showed a com-
parable action with beclomethasone in asth- Pilot Studies
ma control in both adults and children.42,43 on Asthma Pathophysiology:
In vivo studies have shown different phar- The Role of Inflammation
macodynamic properties and although be-
clomethasone has higher receptor affini- Understanding the pathophysiology and in-
ty, Budesonide has higher in vitro potency.44 flammatory triggers and processes of asthma
Like Beclomethasone, the introduction of as well as the effects of ICS on the control of
Budesonide in corticosteroid dependent pa- inflammation and bronchial mucosal infiltra-
tients with severe asthma seemed to offer an tion was a milestone in asthma management.
improvement, allowing substantial reduc- Laboratory and clinical studies established in-
tion or withdrawal of oral prednisolone with- haled steroid treatment as the main therapeu-
out systemic absorbsion.45 Fluticasone pro- tic option for asthma, dethroning bronchodi-
pionate was patented in 1980 and approved lator monotherapy. In 1991 Laitinen LA and
for medical use in 1990.46 In a large interna- coworkers compared the effect of budesonide
tional study fluticasone propionate 1mg/day and terbutaline, on clinical symptoms, lung
was as effective as 2mg/day beclomethasone function, and airway epithelium (on biopsies
dipropionate in the control of severe asthma, obtained with bronchoscopy) in 14 adult pa-
better effect on lung function with less effect tients with newly diagnosed asthma. Budes-
on adrenal function.47,48 The results were sim- onide improved lung function and bronchi-
ilar in lower doses of both medications.49 Oth- al hyperreactivity but most importantly was
er studies also demonstrated that both the dry more effective in ameliorating abnormalities
powder and aerosolized formulations of fluti- of the bronchial epithelium and decreasing
casone propionate had twice the efficacy of inflammation in the airways.57 One year ear-
beclomethasone dipropionate via a pressur- lier Haahtela and coworkers had shown that
ized inhaler, introducing an alternative dry early anti-inflammatory treatment with ICS
powder device (Diskhaler) for asthma drug in newly detected asthma resulted in greater
delivery.50 improvement of symptoms and lung function
than treatment with terbutaline and that the
In the last 30 years, three more inhaled improvement lasted through the entire two-
steroid agents were introduced: Mometa- year study period.58 In a follow-up study, pa-
sone Furoate, Ciclesonide, and Fluticasone tients who had been assigned to terbutaline
Furoate. Mometasone furoate is a highly po- were assigned to ICS and experienced less
tent synthetic glucocorticoid initially used improvement than those who had started on
as a topical dermatologic agent proved to ICS, suggesting that early treatment was more
be an effective treatment for patients with effective than delayed treatmen, ie treatment
mild-to-moderate persistent asthma previous- later into the course of asthma.59,60
ly taking only inhaled β2-adrenergic agonists
when administered either as a once daily or
