Budesonide at different doses for chronic asthma.

Area of Science:

• Pulmonology
• Pharmacology
• Clinical Trials

Background:

• Inhaled budesonide (BUD) is a common treatment for chronic asthma, available in various dosages.
• Understanding the dose-response relationship is crucial for optimizing asthma management.

Purpose of the Study:

• To quantitatively evaluate the efficacy and safety of different inhaled budesonide doses.
• To determine if a clinically significant dose-response profile exists for budesonide in asthma treatment.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched Cochrane Airways Group trial register, contacted authors and manufacturers.
• Included RCTs comparing different budesonide doses in children and adults with chronic asthma.

Main Results:

• In moderate to severe asthma, 800 mcg/d of budesonide significantly reduced exacerbation-related trial withdrawals compared to 200 mcg/d.
• In severe asthma patients on oral corticosteroids, higher budesonide doses (1600 mcg/d) showed clinically significant improvements in FEV1 and PEFR compared to lower doses (200 mcg/d).
• No significant dose-dependent improvements in FEV1, PEFR, or symptoms were observed in mild to moderate asthma patients not treated with oral steroids.

Conclusions:

• Budesonide demonstrates a clinically significant dose-response for improving FEV1 in severe asthma and reducing exacerbations in moderate to severe asthma.
• No significant dose-dependent benefits were found for FEV1, PEFR, or symptoms in mild to moderate asthma patients not on oral steroids.
• While dose-dependent effects on adrenal function were noted, their clinical significance remains unclear.