112 Comparison of the Use Ciclesonide Versus Fluticasone for the Treatment of Asthma in Children

Abstract

BackgroundThe mainteinance treatment in patients with asthma is based in the use of inhaled corticosteroids as ciclesonide and fluticasone. The objective of this stutdy is to compare the utility between ciclesonide versus fluticasone for treatment of asthma in children.MethodsA search was done in journals databases of PubMed, EMBASE, LILACS and Cochrane, from 1996 to 2009. We searched for studies comparing treatment with ciclesonide versus fluticasone in the treatment of children younger than 18 years diagnosed with persistent moderate and severe asthma. The outcomes measured were: FEV 1, peak expiratory flow improvement, absence of nocturnal symptoms, decrease the number of crisis compared to baseline and need to use beta 2 agonist rescue crisis.ResultsWhen making comparisons between ciclesonide and fluticasone in terms of effectiveness in reducing nocturnal symptoms use of beta 2 agonists, peak expiratory flow improvement and prevention of asthma attacks, the studies reported equal effectiveness for both corticosteroids. Studies provide equally effective in improving FEV1. In terms of local effects, it refers in 2 studies presented the same presentation with both steroids, but there are 2 others less concerned with ciclesonide local effects, but both without presenting conclusive results. With respect to adrenal suppression, there are 2 articles that refer to is less with the use of ciclesonide with fluticasone, one adult on the other hand more equal terms the presence of adrenal suppression with both steroids. However, in all studies to make the overall analysis refers without significant changes. Ciclesonide showed the advantage of not inhibiting cortisol secretion. There were studies that compared quality of life by the result of health-related quality of life (PAQLQ) symptom-free days, days without the use of beta 2 agonists and days without nocturnal awakenings, all refers to both corticosteroids as equivalent. By comparing ciclesonide versus placebo, by applying PAQLQ only one study refers improved quality of life with the steroid.ConclusionsCiclesonide is equally effective as fluticasone in the treatment of children with persistent moderate and severe asthma. Besides, bioavailability of ciclesonide allows administration once a day, with less adrenal supression.