A controlled trial of inhaled corticosteroids in patients receiving prednisone tablets for asthma

Abstract

The therapeutic efficacy of inhaled beclomethasone dipropionate and inhaled betamethasone valerate in chronic asthma has been studied in 14 treatment centres in 158 patients who had previously been taking prednisone tablets regularly. Doses of 400 μg daily and 800 μg daily of beclomethasone dipropionate and a dose of 800 μg daily of betamethasone valerate allowed approximately 80% of patients to discontinue prednisone initially and 60% to remain off daily prednisone for 24 weeks. A mean reduction in daily prednisone dose of 8 mg was achieved by patients inhaling corticosteroids whilst placebo inhaler permitted a 5 mg reduction. The three inhaled corticosteroid preparations were equally effective in facilitating prednisone reduction and provided equally good control of asthma, alone or as an ancillary to prednisone. The higher dose of beclomethasone dipropionate was superior to the lower in permitting more patients to remain off daily prednisone for the period of the trial. Although 82% of patients recovered a normal adrenal response to tetracosactrin 24 weeks after prednisone was discontinued and inhaled corticosteroids substituted, 18% still showed some suppression of adrenal function. There was no significant difference between the treatment groups in this. Mild symptoms of corticosteroid withdrawal occurred in approximately 20% of all patients and hoarseness in 9% of all patients, including those on placebo. Respiratory infections were infrequent in all four treatment groups. Symptomatic oropharyngeal candidiasis was confined to the groups inhaling corticosteroids and occurred in approximately 10% of patients, no one preparation being implicated more than any other. In a sample of 26 patients no change in exfoliative cytology was detected and there was no evidence of fungal colonization of the bronchial tree.