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Treatment of steroid-dependent asthma patients with beclomethasone dipropionate aerosol
Abstract:
Fifty-two steroid-dependent adults with chronic perennial asthma were transferred to beclomethasone dipropionate aerosol. The tests demonstrated a significant improvement with beclomethasone in terms of the diary score, bronchodilator use, and PEF and FEV1.0 measurements, as compared with the previous period of prednisolone treatment. Before the transfer, 26 of the patients displayed one or more diseases or symptoms which were probably due to systemic steroid medication. Morning cortisol levels, along with the response to tetracosactrin had in all cases returned to normal when tests were carried out 41 days after transfer to beclomethasone dipropionate. In a group of 12 patients with the lowest 11-OHCS basal values, the mean of their 11-OHCS values during prednisolone treatment was as low as 0.14 plus or minus 0.06 mumol/l, but tetracosactrin challenge induced an elevation to a normal level, 0.33 plus or minus 0.13 mumol/l. After 41 days of beclomethasone treatment, the corresponding values were 0.56 plus or minus 0.90 plus or minus 0.28 mumol/l. Thirty-seven patients experienced one or more disturbing symptoms after transfer to beclomethasone. In many cases, the symptoms of allergic rhinitis were troublesome and persistent leading to a sixfold increase in the use of antihistaminic tablets. When the patients had learned to exhale through the nose following beclomethasone inhalation, the use of antihistaminic tablets again diminished to some extent. Moreover, two cases of ulcerative colitis were encountered during the beclomethasone treatment. During a follow-up period of one year, 14 patients were again receiving prednisolone; most often, this was due to worsening of the asthma because of respiratory infections. During the beclomethasone treatment, a continuous significant improvement in PEF was noted after isoprenaline inhalation, suggesting that further benefit may be obtained by the employment of bronchodilator aerosols as an essential part of the treatment.