Background: Extrafine aerosols may improve asthma symptom control through increased lung deposition of medication to inflamed peripheral airways.
Methods: The effect of switching patients with asthma maintained on up to 2000 microg/day chlorofluorocarbon-beclomethasone dipropionate (CFC-BDP), 1600 microg/day budesonide, 1000 microg/day fluticasone, or 2000 microg/day flunisolide, to a reduced dose of hydrofluoroalkane-134a BDP (HFA-BDP) extrafine aerosol (maximum 800 microg/day) was investigated during an open-label multicentre study. Following a 7-14-day run-in on previous medication, 716 patients were randomised to 24 weeks' treatment with an appropriate reduced dose of HFA-BDP.
Results: Morning peak expiratory flow (AM PEF) measurements showed that, after 24 weeks, the reduced dose of HFA-BDP maintained equivalent lung function compared with all previous medications. Furthermore, asthma symptom scores revealed improvements across all groups and the proportion of symptom free days and nights and beta-agonist free days increased significantly (p < 0.05) in all but one group. Quality of life improved with 80% of patients reporting goo/very good overall asthma control compared with 70% previously. Treatment-associated adverse events were generally infrequent, mild and transient.
Conclusions: Patients on conventional inhaled corticosteroids may reduce their daily steroid dose to 800 microg or less whilst maintaining lung function and improving asthma symptom control by using the extrafine aerosol of HFA-BDP.