Real-life comparison of beclometasone dipropionate as an extrafine- or larger-particle formulation for asthma

Respir Med. 2013 Jul;107(7):987-1000. doi: 10.1016/j.rmed.2013.03.009. Epub 2013 May 3.


Background: Beclometasone dipropionate is an inhaled corticosteroid (ICS) available in both extrafine and larger-particle hydrofluoroalkane formulations. Extrafine beclometasone has greater small airway distribution and inhalation technique tolerance than larger-particle beclometasone; therefore, its use may be associated with improved asthma outcomes at population levels. The study objective was to compare real-life effectiveness of extrafine and larger-particle beclometasone.

Methods: Retrospective matched cohort study including primary care patients with asthma (ages 12-60 and non-smokers 61-80 years) prescribed extrafine or larger-particle beclometasone by metered-dose inhaler. We studied patients receiving their first ICS (initiation population, n = 11,289) or switched from another ICS without dose change (switch population, n = 19,065). The extrafine and larger-particle beclometasone cohorts were matched in each population for demographic and database measures of asthma control during a baseline year; and endpoints assessed during 1 outcome year were adjusted for residual confounding factors.

Results: The odds of no loss of asthma control (no asthma-related hospital attendance, consultation for lower respiratory tract infection, or oral corticosteroids) were significantly higher in the extrafine beclometasone cohorts of both initiation population (adjusted odds ratio [aOR] 1.12; 95% CI 1.02-1.23) and switch population (aOR 1.10; 95% CI 1.01-1.19). The odds of better adherence to ICS therapy were also significantly higher in both extrafine beclometasone cohorts (initiation population, aOR 1.64; 95% CI 1.52-1.75 and switch population, aOR 1.35; 95% CI 1.27-1.43).

Conclusions: These findings are consistent with the hypothesis that delivery of beclometasone in extrafine particle size produces real-life asthma treatment benefits. Clinical trials no. NCT01400217.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / chemistry
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / drug therapy*
  • Beclomethasone / administration & dosage*
  • Beclomethasone / chemistry
  • Beclomethasone / therapeutic use
  • Chemistry, Pharmaceutical
  • Child
  • Drug Administration Schedule
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / chemistry
  • Glucocorticoids / therapeutic use
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data
  • Metered Dose Inhalers
  • Middle Aged
  • Particle Size
  • Primary Health Care
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult


  • Anti-Asthmatic Agents
  • Glucocorticoids
  • Beclomethasone

Associated data