Are there differences among inhaled corticosteroids for asthma treatment?

Published Online: April 16, 2013

Inhaled corticosteroids (ICS) are prescribed as first-line therapy to treat the airway inflammation characteristic of persistent asthma. Several ICS are currently available, but there is little information outside of short-term clinical trials comparing their effects in real life for patients with asthma. The two most commonly used ICS in the United States (US), beclomethasone and fluticasone, are recommended to be prescribed at the same doses but have different characteristics. Fluticasone is a more potent molecule, while beclomethasone is formulated with extrafine particle size and has better distribution throughout the lungs, reaching more of the small peripheral airways than fluticasone.

In research published recently in The Journal of Allergy and Clinical Immunology (JACI), Colice et al investigated whether the better lung deposition with extrafine beclomethasone would result in improved asthma outcomes; they also examined the costs associated with prescribing extrafine beclomethasone and fluticasone. The researchers investigated data from a large US electronic claims database and compared asthma control measures over one year after 10,312 patients with asthma aged 12 to 80 years were started on ICS as either extrafine beclomethasone or fluticasone. Asthma control was defined as the absence of emergency or hospital care, oral corticosteroids, antibiotics for lower respiratory infection, or excessive use of rescue inhalers during the year. The analyses compared outcomes for patients in the two treatment groups who were matched at baseline for their age, sex, and asthma severity.

Patients who were started on extrafine beclomethasone had a 1.2 times greater odds of asthma control than those who were started on fluticasone. They were also less likely to be hospitalized or referred for a respiratory condition. Severe exacerbation rates were similar for the two treatment groups. Matched patients were prescribed significantly higher daily doses of fluticasone, almost one and a half times greater than those of extrafine beclomethasone. Patients prescribed extrafine beclomethasone each incurred $390 less per year in overall health-care costs than those prescribed fluticasone.

These results were similar to those of a prior study in the United Kingdom by the research group, in which patients in a real-life setting receiving extrafine beclomethasone had a similar or better chance of achieving asthma control over 1 year at lower prescribed doses than with fluticasone. The authors noted that improved outcomes with extrafine beclomethasone could be attributed to the extrafine-particle formulation. They speculated that the formulation of ICS, including particle size and resulting action site in the lung, could be important in achieving effective asthma control in real life.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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