Skip to main content
SpringerLink
Log in

Once-Daily Inhaled Corticosteroids in Mild to Moderate Asthma

Improving Acceptance of Treatment

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Despite the established efficacy of inhaled corticosteroids in improving lung function in asthma, there has not been a corresponding improvement in morbidity and mortality associated with the disease, which, in part, may result from non-compliance with the prescribed regimen. The reasons for this are many and varied, but an important measure in improving the level of compliance in asthma patients is simplification of the treatment regimen, which may be achieved by reducing the dose frequency and improving the ease of administration. In clinical trials designed to determine whether a reduction in dose frequency to once daily is associated with similar efficacy to that with more frequent administration, a number of studies have shown that once-daily administration of inhaled corticosteroids in both adults and children is as effective in controlling asthma as twice-daily administration of the same dosage, both when given as initial therapy in corticosteroid-naïve patients and in patients already receiving an inhaled corticosteroid. The drug for which most evidence to support a dosage change from twice-daily to once-daily therapy currently exists is budesonide, though limited evidence with other inhaled corticosteroids such as beclomethasone dipropionate, fluticasone propionate and flunisolide also supports once-daily use. Despite the larger single dosage with once-daily budesonide therapy, there has been no evidence in clinical trials of a greater incidence of local adverse effects such as hoarseness, throat irritation or oropharyngeal candidosis, and no evidence of adrenal suppression or growth retardation.

Since compliance is an important factor that can affect the success or failure of asthma therapy, a reduction in the frequency of administration to once daily offers the potential advantage of improved compliance with treatment and hence better control of asthma. In the short term clinical trials conducted to date, patient preferences have favoured the once-daily regimen over twice-daily administration. When combined with other (e.g. educational) measures to improve patient compliance, a switch from twice-daily (or more frequent) administration to once-daily inhaled corticosteroid therapy seems likely to be beneficial in improving the long term outcome of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The British Thoracic Society, The National Asthma Campaign, The Royal College of Physicians of London in association with the General Practitioner in Asthma Group, the British Association of Accident and Emergency Medicine, the British Paediatric Respiratory Society and the Royal College of Paediatrics and Child Health. The British guidelines on asthma management: 1995 review and position statement. Thorax 1997; 52 Suppl. 1: S2–21

    Google Scholar 

  2. National Heart, Lung, and Blood Institute, National Institutes of Health. Bethesda, Maryland. International consensus report on diagnosis and treatment of asthma. Eur Respir J 1992; 5: 601–41

    Google Scholar 

  3. O’Byrne PM, Pedersen S. Measuring efficacy and safety of different inhaled corticosteroid preparations. J Allergy Clin Immunol 1998; 102: 879–86

    Article  PubMed  Google Scholar 

  4. Pedersen S, O’Byrne P. A comparison of the efficacy and safety of inhaled corticosteroids in asthma. Allergy 1997; 52 Suppl. 39: 1–34

    Article  PubMed  CAS  Google Scholar 

  5. McGill KA, Joseph B, Busse WW. Corticosteroids in the treatment of asthma: practical recommendations. Clin Immunother 1995; 4: 16–48

    Google Scholar 

  6. Rand CS. Patient and regimen-related factors that influence compliance with asthma therapy. Eur Respir Rev 1998; 8: 270–4

    Google Scholar 

  7. Cochrane GM. Compliance and outcomes in patients with asthma. Drugs 1996; 52 Suppl. 6: 12–19

    Article  PubMed  Google Scholar 

  8. Cochrane GM. Compliance in asthma. Eur Respir Rev 1998; 8: 348–50

    Google Scholar 

  9. Schmier JK, Leidy NK. The complexity of treatment adherence in adults with asthma: challenges and opportunities. J Asthma 1998; 35: 455–72

    Article  PubMed  CAS  Google Scholar 

  10. Webb DR. Efficacy of inhaled beclomethasone dipropionate and budesonide in the treatment of asthma. Respir Med 1998; 92 Suppl. B: 7–14

    Article  PubMed  Google Scholar 

  11. Brogden RN, McTavish D. Budesonide: an updated review of its pharmacological properties, and therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44: 375–407

    Article  PubMed  CAS  Google Scholar 

  12. Davis KC, Small RE. Budesonide inhalation powder: a review of its pharmacologic properties and role in the treatment of asthma. Pharmacotherapy 1998; 18: 720–8

    PubMed  CAS  Google Scholar 

  13. Holliday SM, Faulds D, Sorkin EM. Inhaled fluticasone propionate: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic use in asthma. Drugs 1994; 47(2): 318–31

    Article  PubMed  CAS  Google Scholar 

  14. Kelly HW. Establishing a therapeutic index for the inhaled corticosteroids. Pt I. Pharmacokinetic/pharmacodynamic comparison of the inhaled corticosteroids. J Allergy Clin Immunol 1998; 102: S36–51

    Article  PubMed  CAS  Google Scholar 

  15. Stiksa G, Glennow C. Once daily inhalation of budesonide in the treatment of chronic asthma: a clinical comparison. Ann Allergy 1985; 55: 49–51

    PubMed  CAS  Google Scholar 

  16. Weiner P, Weiner M, Azgad Y. Long term clinical comparison of single versus twice daily administration of inhaled budesonide in moderate asthma. Thorax 1995; 50: 1270–3

    Article  PubMed  CAS  Google Scholar 

  17. Thorsson L, Edsbäcker S, Conradson TB. Lung deposition of budesonide from Turbuhaler is twice that from a pressurized metered-dose inhaler (pMDI). Eur Respir J 1994; 7: 1839–44

    Article  PubMed  CAS  Google Scholar 

  18. Selroos O, Pietinhallo A, Riska H. Delivery devices for inhaled asthma medication: clinical implications of differences in effectiveness. Clin Immunother 1996; 6: 273–99

    Google Scholar 

  19. Engel T, Heinig JH, Mailing HJ, et al. Clinical comparison of inhaled budesonide delivered via a pressurized metered dose inhaler or Turbuhaler. Allergy 1989; 44: 220–5

    Article  PubMed  CAS  Google Scholar 

  20. Gunn SD, Choudhury M, Au K, et al. Inhaled steroid treatment reduction in stable asthmatics: a comparison of beclo-methasone/budesonide metered dose inhaler with half dose treatment using budesonide Turbohaler®, given once or twice daily. Br J Clin Res 1997; 8: 67–80

    Google Scholar 

  21. Campbell LM, Gunn SD, Sweeney D, et al. Once daily budesonide: effective control of moderately severe asthma with 800 μg once daily inhaled via Turbohaler when compared with 400 μg twice daily. Eur J Clin Res 1995; 7: 1–14

    Google Scholar 

  22. Chisholm SL, Dekker FW, Knuistingh Neven A, et al. Once-daily budesonide in mild asthma. Respir Med 1998; 92: 421–5

    Article  PubMed  CAS  Google Scholar 

  23. McFadden Jr ER. Budesonide Turbuhaler® once daily administration for patients with mild to moderate chronic asthma. Allergy Asthma Proc 1998; 19: 206–7

    Google Scholar 

  24. Metzger WJ, for the Pulmicort Turbuhaler Study Group. Efficacy and safety of once-daily budesonide dry powder (Pulmicort Turbuhaler®) in adults with inhaled steroid-dependent asthma [abstract]. J Allergy Clin Immunol 1999; 103 (l,Pt2): S131

    Google Scholar 

  25. Möller C, Strömberg L, Oldæus G, et al. Administration of budesonide via Turbuhaler® (200 μg and 400 μg) once daily is as effective as when given twice daily in children with asthma [abstract]. Eur Respir J 1996; 9 Suppl. 23: 115S

    Google Scholar 

  26. Campbell LM, Bodalia B, Gogbashian CA, et al. Once-daily budesonide: 400 μg once daily is as effective as 200 μg twice daily in controlling childhood asthma. Int J Clin Pract 1998; 52: 213–9

    PubMed  CAS  Google Scholar 

  27. Shapiro G, for the Pulmicort Turbuhaler Study Group. Once-daily budesonide dry powder (Pulmicort Turbuhaler®) improves pulmonary function and symptoms in children with inhaled steroid-dependent asthma [abstract]. J Allergy Clin Immunol 1999; 103 (1 Pt 2): S131

    Article  Google Scholar 

  28. McGivern DV, Ward M, Macfarlane JT, et al. Failure of once daily inhaled corticosteroid treatment to control chronic asthma. Thorax 1984; 39: 933–4

    Article  PubMed  CAS  Google Scholar 

  29. Munch EP, Laursen LC, Dirksen A, et al. Dose frequency in the treatment of asthmatics with inhaled topical steroids: comparison between a twice daily and a once daily dosing regimen. Eur Respir J 1985; 67: 254–60

    CAS  Google Scholar 

  30. Gagnon M, Côte J, Milot J, et al. Comparative safety and efficacy of single or twice daily administration of inhaled beclomethasone in moderate asthma. Chest 1994; 105: 1732–7

    Article  PubMed  CAS  Google Scholar 

  31. Johansson L-O. A comparison of once daily regimen of fluticasone propionate (FP) 200 μg and budesonide 400 μg and twice daily regimen of fluticasone propionate (FP) 100 μg [abstract]. Eur Respir J 1998; 12 Suppl. 28: 38

    Google Scholar 

  32. Hodges I, Netherway T. Once daily inhaled fluticasone propionate is as effective as twice daily in children with stable mild to moderate asthma [abstract]. Thorax 1998; 53 Suppl. 4: 55

    Google Scholar 

  33. ZuWallack RL, Rosen JP, Cohen L, et al. The effectiveness of once-daily dosing of inhaled flunisolide in maintaining asthma control. J Allergy Clin Immunol 1997; 99: 278–85

    Article  PubMed  CAS  Google Scholar 

  34. Campbell LM, Watson DG, Venables TL, et al. Once daily budesonide Turbohaler compared with placebo as initial therapy for asthma. Br J Clin Res 1991; 2: 111–22

    Article  Google Scholar 

  35. Jones AH, Langdon CG, Lee PS, et al. Pulmicort® Turbohaler® once daily as initial prophylactic therapy for asthma. Respir Med 1994; 88: 293–9

    Article  PubMed  CAS  Google Scholar 

  36. Venables TL, Addlestone MB, Smithers AJ, et al. A comparison of the efficacy and patient acceptability of once daily budesonide via Turbohaler and twice daily fluticasone propionate via disc-inhaler at an equal daily dose of 400 μg in adult asthmatics. Br J Clin Res 1996; 7: 15–32

    Google Scholar 

  37. Herjavecz I, Serrano A, Blomqvist P. Budesonide Turbuhaler® once or twice daily in non-steroid using patients with asthma [abstract]. Eur Respir J 1997; 10 Suppl. 25: 174

    Google Scholar 

  38. Campbell LM, Gooding TN, Aitchison WRC, et al. Initial loading (400 μg twice daily) versus static (400 μg nocte) dose budesonide for asthma management. Int J Clin Pract 1998; 52: 361–70

    PubMed  CAS  Google Scholar 

  39. van der Molen T, Meyboom-De Jong B, Mulder HH, et al. Starting with a higher dose of inhaled corticosteroids in primary care asthma treatment. Am J Respir Crit Care Med 1998; 158: 121–5

    PubMed  Google Scholar 

  40. Jónasson G, Carlsen K-H, Blomqvist P. Clinical efficacy of low-dose inhaled budesonide once or twice daily in children with mild asthma not previously treated with steroids. Eur Respir J 1998; 12: 1099–104

    Article  PubMed  Google Scholar 

  41. Sciner J, Boltansky H, Chervinsky P, et al. Low dose inhaled fluticasone propionate administered once daily or twice daily via the Diskus is as safe and effective as beclomethasone dipropionate in steroid naïve patients with asthma [abstract]. J Allergy Clin Immunol 1997; 99: 322

    Google Scholar 

  42. Pincus DJ, Szefler SJ, Ackerson LM, et al. Chronotherapy of asthma with inhaled steroids: the effect of dosage timing on drug efficacy. J Allergy Clin Immunol 1995; 95: 1172–8

    Article  PubMed  CAS  Google Scholar 

  43. Sorkness CA. Establishing a therapeutic index for the inhaled corticosteroids. Pt II. Comparison of systemic activity and safety among different inhaled corticosteroids. J Allergy Clin Immunol 1998; 102: S52–64

    Article  PubMed  CAS  Google Scholar 

  44. Prenner BM. Hypothalamic-pituitary-adrenal axis suppression during inhaled or intranasal corticosteroid treatment. Adv Ther 1996; 13: 154–60

    Google Scholar 

  45. Wilson AM, Clark DJ, Devlin MM, et al. Adrenocortical activity with repeated administration of once-daily inhaled fluticasone propionate and budesonide in asthmatic adults. Eur J Clin Pharmacol 1998; 53: 317–20

    Article  PubMed  CAS  Google Scholar 

  46. Heuck C, Wolthers OD, Kollerup G, et al. Adverse effects of inhaled budesonide (800 μg) on growth and collagen turnover in children with asthma: a double-blind comparison of once-daily versus twice-daily administration. J Pediatr 1998; 133: 608–12

    Article  PubMed  CAS  Google Scholar 

  47. Levine MAH, Gaebel KA, Goldsmith CH, et al. Drug utilization and quality of life in patients with airways limitations using inhaled steroids on a PRN basis. Pharmacoepidemiol Drug Saf 1997; 6 Suppl. 2: S84

    Google Scholar 

  48. Bender B, Milgrom H, Rand C. Nonadherence in asthmatic patients: is there a solution to the problem? Ann Allergy Asthma Immunol 1997; 79: 177–86

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Southbank Surgery, 17-19 Southbank Road, Kirkintilloch, Glasgow, G66 1NH, UK

    L. Malcolm Campbell

Authors
  1. L. Malcolm Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campbell, L.M. Once-Daily Inhaled Corticosteroids in Mild to Moderate Asthma. Drugs 58 (Suppl 4), 25–33 (1999). https://doi.org/10.2165/00003495-199958004-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199958004-00004

Keywords

Search

Navigation