Efficiency of inhaled versus oral steroid treatment of chronic asthma

The therapeutic efficiency of oral vs. inhaled steroid treatment for chronic asthma was compared in several graded-dose, double-blind controlled trials. Inhaled steroid proved significantly more effective than alternate-morning prednisone when the two regimens were compared in the same patients at equivalent levels of systemic glucocorticoid activity. Furthermore, if given in sufficient dosage, inhaled steroids proved equally as effective as oral prednisone given daily, and better tolerated than the latter. The data support a broadening of the therapeutic role of inhaled steroid drugs to include higher dosages and patients with more severe grades of asthma. To facilitate this, concentrated formulations are needed. Until the latter become available to the practitioner, combinations of inhaled plus oral steroid treatment may be used, since these have been shown to improve the efficacy of chronic steroid therapy without worsening its adverse effects.