GRADED DOSE ASSESSMENT OF EFFICACY OF BECLOMETHASONE DIPROPIONATE AEROSOL FOR SEVERE CHRONIC ASTHMA

[摘要] In a 26 wk double-blind controlled study of 34 patients whose asthma was poorly controlled despite oral steroids, valuable clinical and pulmonary function improvement was derived by adding beclomethasone aerosol to the prednisone regimen. The amount of improvement correlated linearly with beclomethasone dosage over the range 200-1600 .mu.g/day. These patients required relatively high dosage. Success in achieving asymptomatic status was only 26% with the conventional 400 .mu.g/day and 60% at 1600 .mu.g/day. Oropharyngeal candidiasis was also dose-related but did not prohibit the use of high-dosage beclomethasone. Respiratory infections, physical signs, blood glucose and electrolytes were unaffected by the drug. A dose-related suppression of cortisol secretion was demonstrated, but about 1/4 of the group had normal plasma cortisol even at 1600 .mu.g/day plus the oral prednisone. An individualized risk-benefit assessment seems a better basis for choosing an optimal beclomethasone regimen for each patient than adherence to a conventionalized fixed dosage of 400 .mu.g/day. This requires definition of a specific goal of treatment in the individual patient and the beclomethasone dosage required to achieve it, the adrenocortical functional response of that particular patient to the desired dose of beclomethasone, and the presence and degree of any dose-limiting constaints such as preexisting complications of steriod use.