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Evidence summaries

Inhaled Beclomethasone Versus Budesonide for Chronic Asthma

There appear to be no differences in relative efficacy between beclomethasone and budesonide, although BUD via Turbohaler appears to be more effective than BDP via either Rotahaler of metered dose device. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 24 studies with a total of 1 174 subjects. A meta-analysis of crossover studies did not demonstrate a significant difference between BDP and BUD for FEV1, morning PEF, evening PEF, asthma symptoms or rescue beta2 agonist use, over a dose range of 400 to 1000 µg/d. The majority of the trials may have flaws related to the lack of washout and/or failure to exclude carryover effects. A single study with adequate washout showed that BUD 400 µg/d delivered via Turbohaler dry powder inhaler may be more effective than BDP 400 µg/d delivered via rotahaler in reducing histamine-bronchial hyperresponsiveness. A meta-analysis of two parallel group, dose down-titration studies (231 patients) showed that less budesonide delivered via a Turbohaler was required to maintain control in adult asthmatics compared to BDP delivered via metered dose inhaler with or without a spacer.

Comment: The quality of evidence is downgraded by study limitations.

    References

    • Adams N, Bestall JM, Jones PW. Inhaled beclomethasone versus budesonide for chronic asthma. Cochrane Database Syst Rev 2002;(1):CD003530. [PubMed].

Primary/Secondary Keywords