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Related Concept Videos

Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids01:25

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Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
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Asthma, a common chronic respiratory condition, is classified considering the frequency and severity of symptoms alongside lung function impairment. Understanding this classification is essential for appropriate treatment and management. Here's a detailed look at the classification of asthma and its clinical features and complications:
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Asthma presents with a characteristic pattern of episodic respiratory symptoms that reflect underlying airway inflammation, bronchoconstriction, and mucus hypersecretion. Although severity varies among individuals, certain clinical manifestations are considered hallmarks of the disorder and often guide diagnosis and assessment.Respiratory SymptomsA persistent cough is one of the most common early features of asthma. It is frequently dry and tends to worsen at night or in the early morning,...
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Related Experiment Video

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A Reversible, Non-invasive Method for Airway Resistance Measurements and Bronchoalveolar Lavage Fluid Sampling in Mice
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Significant variability in response to inhaled corticosteroids for persistent asthma.

Stanley J Szefler1, Richard J Martin, Tonya Sharp King

  • 1National Jewish Medical and Research Center, Department of Pediatrics, Denver, CO 80206, USA.

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|March 19, 2002
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Low to medium doses of inhaled corticosteroids (beclomethasone dipropionate and fluticasone propionate) achieved near-maximal lung function benefits in asthma patients. Higher doses increased systemic effects without significantly improving lung function, highlighting individual response variability.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Clinical Medicine

Background:

  • A standardized clinical model is essential for comparing the efficacy of inhaled corticosteroids (ICSs).
  • Persistent asthma management requires a clear understanding of ICS benefit-risk profiles.

Purpose of the Study:

  • To compare the relative efficacy and systemic effects of two ICSs, beclomethasone dipropionate (BDP) and fluticasone propionate (FP), in a dose-response manner.
  • To evaluate the benefit-risk ratio of BDP and FP in patients with persistent asthma.

Main Methods:

  • A 24-week, open-label, multicenter trial involving 30 persistent asthma patients.
  • Patients received escalating doses of BDP (168, 672, 1344 µg/day) or FP (88, 352, 704 µg/day) via metered-dose inhaler (MDI) with a spacer for 6-week intervals.
  • A final 3-week interval involved FP dry powder inhaler (DPI) at 2000 µg/day. Benefit was measured by FEV(1) and PC(20); risk by cortisol suppression.

Main Results:

  • Near-maximal improvements in FEV(1) and PC(20) were observed at low-to-medium doses for both BDP-MDI and FP-MDI.
  • Higher doses and FP-DPI did not significantly enhance lung function efficacy but increased dose-dependent cortisol suppression.
  • Significant intersubject variability in treatment response was noted, with predictors including exhaled nitric oxide, bronchodilator reversibility, FEV(1)/FVC ratio, sputum eosinophils, and age of asthma onset.

Conclusions:

  • Low-to-medium doses of BDP and FP provide substantial lung function benefits in many asthma patients.
  • Higher ICS doses increase systemic effects (cortisol suppression) without proportional increases in lung function efficacy.
  • Individual patient characteristics significantly influence ICS responsiveness, suggesting potential need for personalized dosing strategies or alternative therapies for severe cases or specific treatment goals.