Beclomethasone dipropionate given to adult asthmatics through a new spacer device: effects of high-dose...

The usefulness of a metered-dose inhaler equipped with a new spacer device (Jet spacer) was evaluated and compared with that of a standard actuator in the administration of high-dose inhaled beclomethasone dipropionate (0.5 mg four times daily) to adults with moderate asthma. After a 2-week run-in period, 36 patients were enrolled in a 4-week study according to a randomized, parallel-group design. Efficacy was assessed by measurements of pulmonary function and daily beta 2-agonist consumption. Morning serum and 24-hour urinary cortisol levels were measured at baseline and after treatment; adrenocorticotropic hormone (ACTH) stress testing was also done. Spirometric parameters significantly improved in both groups; peak expiratory flow rate measured at the final visit was significantly higher (P < .01) in the group using the Jet spacer than in patients using the standard actuator. Beta 2-agonist consumption decreased in both groups. The number of patients with a normal response to ACTH was significantly higher (P < .01) in the Jet group than in the standard actuator group; concomitant urinary cortisol excretion decreased significantly (P < .05) in the standard actuator group. Local irritation was reported by 1 patient in the Jet group and by 2 patients in the standard actuator group. Use of the new Jet spacer was found to reduce the potential for adrenal suppression and increase the efficacy of high-dose inhaled beclomethasone dipropionate given to adults with asthma.