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.
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