TY - JOUR T1 - Nebulised budesonide using a novel device in patients with oral steroid-dependent asthma JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/09031936.00152014 SP - ERJ-01520-2014 AU - Claus Vogelmeier AU - Peter Kardos AU - Thomas Hofmann AU - Sebastian Canisius AU - Gerhard Scheuch AU - Bernhard Muellinger AU - Karlheinz Nocker AU - Guenter Menz AU - Klaus F. Rabe Y1 - 2014/12/10 UR - http://erj.ersjournals.com/content/early/2014/12/10/09031936.00152014.abstract N2 - This phase 2/3 randomised, parallel-group, placebo-controlled trial investigated oral corticosteroid (OCS)-sparing efficacy, safety and tolerability of nebulised budesonide (Bud) administered with a novel computer-controlled, compressor-driven inhalation system (AKITA) as add-on therapy to Global Initiative for Asthma step 5. Patients (18–65 years) with OCS-dependent asthma were randomised (2:1:1:1) to receive 18-week, twice-daily, double-blind treatment with AKITA inhaled corticosteroid (AICS)-Bud 1 mg, AICS-Bud 0.5 mg, AICS-placebo or open-label Bud 1 mg administered by conventional nebuliser (CN-Bud). OCS doses were tapered until week 14. 199 patients started treatment. More AICS-Bud 1 mg (80.0%) than placebo-treated (62.5%) patients had daily OCS doses reduced ⩾50%, with clinical stability to week 18 (one-sided p=0.02; treatment difference: 17.5% (95% CI 0.1–34.9%), two-sided p=0.04). Mean±sd forced expiratory volume in 1 s improved (from baseline to week 18) for AICS-Bud 1 mg (239±460 mL, p<0.001) and AICS-Bud 0.5 mg (126±345 mL, p=0.01) but not placebo (93±419 mL, p=0.36) or CN-Bud (137±459 mL, p=0.18). Fewer AICS-Bud 1 mg-treated patients experienced asthma exacerbations (7.5%) compared with placebo (17.5%) or CN-Bud (22.5%). All treatments were well tolerated. Budesonide applied with AKITA allowed significant meaningful OCS reduction in OCS-dependent asthma patients while improving pulmonary function and maintaining exacerbation control. Nebulised budesonide applied with AKITA allowed significant, meaningful OCS reduction in GINA step 5 asthma patients http://ow.ly/EpG7N ER -