Asthma budesonide

Turbohaler first multidose dry powder inhaler for budesonide (asthma) (1990)... 

Asthma is a chronic inflammatory disease. Therefore steroids represent the most important and most frequently used medication. Already after the fust treatment, steroids reduce cellular infiltration, inflammation, and the LAR, whereas changes in the EAR require prolonged treatment to lower the existent IgE levels. The mechanisms of steroid actions are complex and only incompletely understood. Besides their general antiinflammatory properties (see chapter glucocorticoids), the reduction of IL-4 and IL-5 production from T-lymphocytes is particularly important for asthma therapy. The introduction of inhaled steroids, which have dramatically limited side effects of steroids, is considered one of the most important advancements in asthma therapy. Inhaled steroids (beclomethasone, budesonide, fluticasone, triamcinolone, momethasone) are used in mild, moderate, and partially also in severe asthma oral steroids are used only in severe asthma and the treatment of status asthmaticus. Minor side effects of most inhaled steroids are hoarseness and candidasis, which are avoided by the prodrug steroid ciclesonide. 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

Low-dose inhaled corticosteroids are the treatment of choice for women with mild persistent asthma. Budesonide is preferred, but other inhaled corticosteroids that were used effectively prior to pregnancy can be continued. 

Asthma is managed by the use of an inhaled bronchodilator prescribed on an as-required (p.r.n.) basis to relieve acute attacks and administration of an inhaled corticosteroid as maintenance therapy. Budesonide is available as inhaled corticosteroid. Amoxicillin or another antibacterial agent may be required for short-term periods. Codeine, being an antitussive, should be used with caution in asthmatics and certainly not routinely. 

The majority of the marketed products are used for asthma and COPD. Typical agents that are used for these indications are fl2-agonists such as salbutamol (albuterol), Terbutalin or formoterol, corticosteroids such as budesonide, FUxotide or beclomethasone and mast-cell stabilizers such as sodium cromoglycate or nedocromil. 

Asthma, chronic Maintenance and prophylactic treatment of asthma includes patients who require systemic corticosteroids and those who may benefit from systemic dose reduction/elimination for the maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age (budesonide respules). 

Budesonide turbuhaler- In all patients, it is desirable to titrate to the lowest effective dose once asthma stability is achieved. 

Improvement in asthma control following inhaled administration of budesonide can occur within 24 hours of treatment initiation, although maximum benefit may not be achieved for 1 to 2 weeks or more. 

Budesonide respules - Administer by the inhaled route via jet nebulizer connected to an air compressor in asthmatic patients 12 months to 8 years of age. Improvement in asthma control following inhaled administration of budesonide can occur within 2 to 8 days of initiation of treatment, although maximum benefit may not be achieved for 4 to 6 weeks. It is desirable to downward-titrate to the lowest effective dose once asthma stability is achieved. In symptomatic children not responding to nonsteroidal therapy and in patients who require maintenance therapy of their asthma, a starting dose of 0.25 mg once daily may also be considered. 

O Byrne PM, Bisgaard H, Godard PP et al. Budesonide-formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005 171 129-36. 

Rabe KF, Atienza T, Magyar P, Larsson P, Jorup C, Lal-loo UG. Effect of budesonide in combination with for-moterol for reliever therapy in asthma exacerbations a randomized controlled, double-blind study. Lancet 2006 368 744-53. 

Beclomethasone dipropionate, and several other glucocorticoids—primarily budesonide and flunisolide and mometasone furoate, administered as aerosols—have been found to be extremely useful in the treatment of asthma (see Chapter 20). 

Inhaled budesonide has been studied in the management of moderately severe, acute asthma in children (24). After... 

The effect of supplementary inhaled budesonide in acute asthma has been evaluated in a randomized, double-blind comparison with standard treatment in 44 children aged 6 months to 18 years with a moderate to severe exacerbation of asthma (26). Prednisone 1 mg/kg orally and nebulized salbutamol (0.15 mg/kg) every 30 minutes for three doses and then every hour for 4 hours were given to all children. In addition, each child was given 2 mg of nebulized budesonide or nebulized isotonic saline. There was a more rapid discharge rate in the budesonide group. There were no adverse effects. The authors concluded that nebulized budesonide may be an effective adjunct to oral prednisone in the management of moderate to severe exacerbations of asthma. 

A 32-year-old woman s asthma regimen was changed from budesonide to fluticasone propionate 500 micrograms/day and salmeterol (44). Eight months later, she was evaluated because of excessive bodyweight gain her serum cortisol concentration was 16 nmol/1. Fluticasone propionate was replaced with nedocromil and 1 month later her serum cortisol concentration had normalized. 

Tixocortol pivalate is a marker for glucocorticoid contact allergy, as a positive patch test suggests established contact allergy to hydrocortisone, prednisolone, and their derivatives (95). A literature search via Medline from 1966 to May 2000 revealed only one patient hypersensitive to tixocortol pivalate and budesonide in a pilot study in 34 patients (10 with asthma, 13 with rhinitis, 11 with both) (96). From case reports, the prevalence of glucocorticoid-induced contact allergy has been estimated at 2.9-5%. 

An asthmatic patient using inhaled budesonide and salbutamol developed an acute asthma attack. Despite emergency treatment the patient deteriorated, requiring endotracheal intubation and assisted ventilation, and there was no improvement until the glucocorticoid was withdrawn, after which there was steady improvement. Skin prick tests with prednisolone, sodium hemisuccinate, and 6-methylprednisolone-sodium hemisuccinate were positive. Thirty minutes after intradermal 6-methylprednisolone-sodium hemisuccinate 4 mg, the patient developed a dry cough, dyspnea, and wheezing and a 17% fall in FEVi. 

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