A Comparison of a Budesonide-Based and a Beclomethasone/Prednisolone-Based Management Strategy for the Treatment of Severe Asthma in General Practice
Kevin A. MacLusky
Clifford C. Godley
Pamela L. Todd
Objective: Patients with severe asthma often require short courses of oral corticosteroids in addition to their daily inhaled steroid to maintain adequate lung function. The objective of this study was to compare two management strategies for the treatment of severe asthma. A budesonide-based management strategy and a beclomethasone/prednisolone-based management strategy were compared for efficacy and tolerability. Design and Setting: 50 patients were randomised into this 24-week, open, parallel group comparison. Patients received either a budesonide-based treatment strategy (n = 21) - budesonide 800microg twice daily via Turbohaler(R) with 2mg twice daily nebulised budesonide for 7 to 14 days on asthma exacerbation, or a beclomethasone/prednisolone-based treatment strategy (n = 29, 28 evaluable) - beclomethasone 500 to 1000microg twice daily via metered dose inhaler (MDI) plus large volume spacer with 40mg oral prednisolone daily, for 7 to 14 days on asthma exacerbation. Results: Patients receiving the budesonide treatment strategy required fewer courses of rescue steroid during the 24-week study period than patients receiving the beclomethasone/prednisolone treatment strategy (mean 1.7 vs 3.8: p < 0.05). A greater proportion of patients in the beclomethasone/prednisolone group compared with the budesonide group required at least one course of rescue steroid during the study period (75 vs 38%; p < 0.05). The frequency of adverse events reported was similar for both groups (86 vs 93%). Conclusions: For the treatment of patients with severe asthma, a budesonide-based management strategy appears to benefit asthma control (reduction in number of exacerbations) and is as well tolerated as the commonly used treatment of beclomethasone via MDI plus large volume spacer with prednisolone on exacerbation.
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