Problemi correnti
I glucocorticoidi per via inalatoria
INHALED GLUCOCORTICOIDS
GIORGIO LONGO
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Giugno 1998 - pagg. 367 -373
Abstract
In spite of the progress of scientific knowledge,
asthma remains an intractable disease.
The target of the therapeutic strategy
is therefore the greatest possible improvement
of the patient’s quality of life.
Inhaled glucocorticoids (IGCS) are at present
the best therapeutic tool in chronic
asthma. They have a strong local activity
with minimal systemic effects. Atopic patients
with persistent airflow obstruction
should receive IGCS irrespective of age.
IGCS should be used as first therapeutic
step to reduce bronchial hyperreactivity
while other drugs such as sodium cromoglycate
should be used only to maintain clinical
remission. The choice of the best device
to administer IGCS (inhaler, spray, turbohaler,
nebulizer) depends on the age
and the needs of the child. The daily dose
should not exceed 10-15 mg (beclometasone
equivalent) and, as a rule, the minimum
effective dose should be used. A single cumulative
dose at 5 p.m. is as effective as
two or three divided doses. Side effects are
negligible when these indications are followed.
At present, there is not clear evidence
for IGCS in the treatment of acute asthma
attacks.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Haahtela T, Jarvinen M, Kava T, et al: Effects
of reducing or discontinuing inhaled
budesonide in patients with mild asthma. N
Engl J Med 331, 700-5, l994.
2. Agertoft L, Pedersen S: Effects of longterm treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med 88, 373-81, 1994.
3. Gerritsen J, Koeter GH, Postma DS, et al: Prognosis of asthma from childhood to adulthood. Am Rev Respir Dis 140, 1325-30, 1989.
4. Oswald H, Phelan PD, Lanigan A, et al: Childhood asthma and lung function in midadult life. Pediatr Pulmonol 23, 14-20, 1997.
5. Warner JO, Naspitz CK, Cropp GJ: Third international pediatric consensus statement on the management of childhood asthma. Pediatr Pulmonol 25, 1-17, 1998.
6. The British guidlines on asthma management 1995: review and position statement. Thorax 52 (suppl.1), S1-S21, 1997.
7. Società Italiana Malattie Respiratorie Infantili. Consensus sull’asma infantile “Progetto GINA”, Catania 6-7 febbraio 1988. Rivista Italiana di Broncopneumologia Pediatrica, in stampa.
8. Svendsen UG, Frolund L, Madsen F, et al: A comparison of the effects of sodium cromoglycate and beclomethasone dipropionate on pulmonary function and bronchial hyperreactivity in subjects with asthma. J All Clin Immunol 80, 68-74, 1987.
9. Petersen W, Petersen FK, Friis B, et al: Sodium cromoglycate as a replacement for inhaled corticosteroids in mild-to-moderate childhood asthma. Allergy 51, 870-875, 1996.
10. Martinez FD, Wright AL, Taussig LM, et al: Asthma and wheezing in the first six years of life. N Engl J Med 332, 133-8, 1995.
11. Noble V, Ruggins NR, Everard ML, Milner AD: Inhaled budesonide for chronic wheezing under 18 month of age. Arch Dis Child 67, 285-8, 1992.
12. Gleeson JGA, Price JF: Controlled trial of budesonide given by the nebuhaler in preschool children with asthma. BMJ 297, 163-6, 1988.
13. Wilson N, Sloper K, Silverman M: Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child 72, 317-20, 1995.
14. Selroos O, Halme M: Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from metered dose inhaler and dry powder inhaler. Thorax 46, 891-4, 1991.
15. Girbino G, Lauriello G, Andò F, et al: Beclomethasone dipropionate given to adult asthmatics through a new spacer device: effects of hight-dose administration. Advances in Therapy 13, 220-29, 1996.
16. Thorsson L, Edsbacker S: Lung deposition of budesonide from turbohaler is twice that from a pressurized metered dose inhaler. Thorax 48, 434 abstract, 1993.
17. Pedersen S, Hansen OR: Budesonide treatment of moderate and severe asthma in children: a dose response study. J All Clin Immunol 95, 29-33, 1995.
18. Agertoft L, Pedersen S: Importance of the inhalation device on the effect of budesonide. Arch Dis Child 69, 130-133, 1993.
19. Toogood JH, White FA, et al: Comparison of the antiasthmatic, oropharingeal, and systemic glucocorticoid effects of budesonide administered through a pressurized aerosol plus spacer or the Turbohaler dry powder inhaler. J All Clin Immunol 99,186-93, 1997.
20. Milgrom H, Bender B, Ackerson L: Noncompliance and treatment failure in children with asthma. J All Clin Immunol 98, 1051-7, 1996.
21. The nebulizer project group of the British Thoracic Society standards of care committee. Current best practice for nebulizer treatment. Thorax 52, suppl 2, 1997.
22. Malo JL, Cartier A, Merland N, et al: Four-time-a-day dosing frequency is better than a twice-a-day regimen in subjects requiring a hight-dose inhaled steroid, budesonide, to control moderate to severe asthma. Am Rev Respir Dis 140, 624-8, 1989.
23. Pinctus DJ, Humeston TR, Martin RJ: Further studies on the chronotherapy of asthma with inhaled steroid: the effect of dosage timimg on drug efficacy. J All Clin Immunol 100, 771-4, 1997.
24. Pedersen S, O’Byrne P: A comparison of the efficacy and safety of inhaled corticosteroids in asthma. Allergy Vol. 52, Supplement 39, Sl-S29, 1997.
25. Johnson M: Pharmacodynamics and pharmacokinetics of inhaled glucocorticoids. J All Clin Immunol 97, 169-76, 1996.
26. Barnes PJ, Pedersen S: Efficacy and safety of inhaled corticosteroids in asthma. Am Rev Respir Dis 148, S1-26, 1993.
27. Kamada AK, Szefler SJ: How should inhaled glucocorticoids be compared? J All Clin Immunol 99, 735-7, 1997.
28. Svendsen UG, Jorgensen H: Inhaled nedocromil sodium as additional treatment to high dose inhaled corticosteroids in the management of bronchial asthma. Eur Respir J 4, 992-9, 1991.
29. Greening AP, Ind PW, Northfield, Shaw G: Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet 344, 219-24, 1994.
30. Pauwels RA, Lofdahl CG, et al: Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 337, 1405-11, 1997.
31. Evans DJ, David MB, Taylor A, et al: A comparison of low dose inhaled budesonide plus theophilline and high-dose inhaled budesonide for moderate asthma. N Engl J Med 337, 1412-8, 1997.
32. Sugiyama K, Motoijama S, et al: Anti-infiammatory effects of theofilline (Uniphyl) in mild asthmatic. J All Clin Immunol (suppl), S324, 1997.
33. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report March 1993. Bethesda: National Heart, Lung and Blood Istitute, National Istitutes of Health. US Department of Heath and Human Services, 1995.
34. Van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, et al: Effect of 22 months’ treatment with inhaled corticosteroids and/or beta-2 agonists on lung function, airway responsiveness, and symptoms in children with asthma. Am Rev Respir Dis 146, 547-54, 1992.
35. Allen DB: Influence of inhaled corticosteroids on growth: a pediatric endocrinologist’s perspective. Acta Paediatr 87, 123-9, 1998.
36. Russel G: Asthma and growth. Arch Dis Child 69, 695-8, 1993.
37. Allen DB, Mullen M, Mullen B: A meta analysis of the effect of oral and inhaled corticosteroids on growth. J All Clin Immunol 93, 967-76, 1994.
38. Silverstein AU, Yunginger JW, et al: Attained adult height after childhood asthma: effect of glucocorticoid therapy. J All Clin Immunol 99, 466-74, 1997.
39. Kalberg J, Gelander L, Albertsson-Wikland K: Distinctions between short and long term human growth studies. Acta Pediatr 83, 631-4, 1993.
40. Doull IJM, Campbell MJ, et al: Duration of growth suppressive effects of regular inhaled corticosteroids. Arch Dis Child 78, 172-3, 1998.
41. Boot AM, de Jongste JC, et al: Bone mineral density and bone metabolism of prepuberal children with asthma after long-term treatment with inhaled corticosteroids. Pediatr Pneumol 24, 379-84, 1997.
42. Law CM, Honour JW, et al: Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet i, 942, 1986.
43. Zwaan CM, Odinik RJH, et al: Acute adrenal insufficiency after discountinuation of inhaled corticosteroid therapy. Lancet 340, 1289-90, 1992.
44. Turpeinem M, Sovra R, et al: Change in carbohydrate and lipid metabolism in children with asthma inhaling budesonide. J All Clin Immunol 88, 384-9, 1991.
45. Cumming RG, Mitchell P, et al: Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 337, 8-14, 1997.
46. Choong K, Zwaigenbaum L, et al: Severe varicella after low dose inhaled corticosteroids. Ped Inf Dis J 14, 809-11, 1995.
47. Cotton AMJ: Severe chickenpox after intranasal use of corticosteroids. J Pediatr 123, 577-9, 1993.
48. Nursoy MA, Bakir M, et al: The course of chickenpox in asthmatic children receiving inhaled budesonide. Ped Infect Dis J 16, 74-5, 1997.
49. Ellul-Micallef R, Johansson SA: Acute dose- response studies in bronchial asthma with a new corticosteroid, budesonide. Br J Clin Pharmac 15, 419-22, 1983.
50. Wilson NM, Silverman M: Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. Arch Dis Child 65, 407-410, 1990.
51. Youngchaiyud P, Maranetra N, et al: Can inhaled steroids replace oral therapy after an acute asthma attack? Eur Respir J 9 (suppl), S23, 3, 1996.
52. Brunette MG, Lands L, et al: Childhood asthma: prevention of attacks with shortterm corticosteroid treatment of upper respiratory tract infection. Pediatrics 81, 624-29, 1988.
53. Connet G, Lenney W: Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child 68, 85-7, 1993.
54. Svedmyr J, Nyberg E, et al: Intermittent treatment with inhaled steroids for deterioration of asthma due to upper respiratory tract infections. Acta Paediatr 84, 884-8, 1995.
2. Agertoft L, Pedersen S: Effects of longterm treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med 88, 373-81, 1994.
3. Gerritsen J, Koeter GH, Postma DS, et al: Prognosis of asthma from childhood to adulthood. Am Rev Respir Dis 140, 1325-30, 1989.
4. Oswald H, Phelan PD, Lanigan A, et al: Childhood asthma and lung function in midadult life. Pediatr Pulmonol 23, 14-20, 1997.
5. Warner JO, Naspitz CK, Cropp GJ: Third international pediatric consensus statement on the management of childhood asthma. Pediatr Pulmonol 25, 1-17, 1998.
6. The British guidlines on asthma management 1995: review and position statement. Thorax 52 (suppl.1), S1-S21, 1997.
7. Società Italiana Malattie Respiratorie Infantili. Consensus sull’asma infantile “Progetto GINA”, Catania 6-7 febbraio 1988. Rivista Italiana di Broncopneumologia Pediatrica, in stampa.
8. Svendsen UG, Frolund L, Madsen F, et al: A comparison of the effects of sodium cromoglycate and beclomethasone dipropionate on pulmonary function and bronchial hyperreactivity in subjects with asthma. J All Clin Immunol 80, 68-74, 1987.
9. Petersen W, Petersen FK, Friis B, et al: Sodium cromoglycate as a replacement for inhaled corticosteroids in mild-to-moderate childhood asthma. Allergy 51, 870-875, 1996.
10. Martinez FD, Wright AL, Taussig LM, et al: Asthma and wheezing in the first six years of life. N Engl J Med 332, 133-8, 1995.
11. Noble V, Ruggins NR, Everard ML, Milner AD: Inhaled budesonide for chronic wheezing under 18 month of age. Arch Dis Child 67, 285-8, 1992.
12. Gleeson JGA, Price JF: Controlled trial of budesonide given by the nebuhaler in preschool children with asthma. BMJ 297, 163-6, 1988.
13. Wilson N, Sloper K, Silverman M: Effect of continuous treatment with topical corticosteroid on episodic viral wheeze in preschool children. Arch Dis Child 72, 317-20, 1995.
14. Selroos O, Halme M: Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from metered dose inhaler and dry powder inhaler. Thorax 46, 891-4, 1991.
15. Girbino G, Lauriello G, Andò F, et al: Beclomethasone dipropionate given to adult asthmatics through a new spacer device: effects of hight-dose administration. Advances in Therapy 13, 220-29, 1996.
16. Thorsson L, Edsbacker S: Lung deposition of budesonide from turbohaler is twice that from a pressurized metered dose inhaler. Thorax 48, 434 abstract, 1993.
17. Pedersen S, Hansen OR: Budesonide treatment of moderate and severe asthma in children: a dose response study. J All Clin Immunol 95, 29-33, 1995.
18. Agertoft L, Pedersen S: Importance of the inhalation device on the effect of budesonide. Arch Dis Child 69, 130-133, 1993.
19. Toogood JH, White FA, et al: Comparison of the antiasthmatic, oropharingeal, and systemic glucocorticoid effects of budesonide administered through a pressurized aerosol plus spacer or the Turbohaler dry powder inhaler. J All Clin Immunol 99,186-93, 1997.
20. Milgrom H, Bender B, Ackerson L: Noncompliance and treatment failure in children with asthma. J All Clin Immunol 98, 1051-7, 1996.
21. The nebulizer project group of the British Thoracic Society standards of care committee. Current best practice for nebulizer treatment. Thorax 52, suppl 2, 1997.
22. Malo JL, Cartier A, Merland N, et al: Four-time-a-day dosing frequency is better than a twice-a-day regimen in subjects requiring a hight-dose inhaled steroid, budesonide, to control moderate to severe asthma. Am Rev Respir Dis 140, 624-8, 1989.
23. Pinctus DJ, Humeston TR, Martin RJ: Further studies on the chronotherapy of asthma with inhaled steroid: the effect of dosage timimg on drug efficacy. J All Clin Immunol 100, 771-4, 1997.
24. Pedersen S, O’Byrne P: A comparison of the efficacy and safety of inhaled corticosteroids in asthma. Allergy Vol. 52, Supplement 39, Sl-S29, 1997.
25. Johnson M: Pharmacodynamics and pharmacokinetics of inhaled glucocorticoids. J All Clin Immunol 97, 169-76, 1996.
26. Barnes PJ, Pedersen S: Efficacy and safety of inhaled corticosteroids in asthma. Am Rev Respir Dis 148, S1-26, 1993.
27. Kamada AK, Szefler SJ: How should inhaled glucocorticoids be compared? J All Clin Immunol 99, 735-7, 1997.
28. Svendsen UG, Jorgensen H: Inhaled nedocromil sodium as additional treatment to high dose inhaled corticosteroids in the management of bronchial asthma. Eur Respir J 4, 992-9, 1991.
29. Greening AP, Ind PW, Northfield, Shaw G: Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet 344, 219-24, 1994.
30. Pauwels RA, Lofdahl CG, et al: Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 337, 1405-11, 1997.
31. Evans DJ, David MB, Taylor A, et al: A comparison of low dose inhaled budesonide plus theophilline and high-dose inhaled budesonide for moderate asthma. N Engl J Med 337, 1412-8, 1997.
32. Sugiyama K, Motoijama S, et al: Anti-infiammatory effects of theofilline (Uniphyl) in mild asthmatic. J All Clin Immunol (suppl), S324, 1997.
33. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report March 1993. Bethesda: National Heart, Lung and Blood Istitute, National Istitutes of Health. US Department of Heath and Human Services, 1995.
34. Van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, et al: Effect of 22 months’ treatment with inhaled corticosteroids and/or beta-2 agonists on lung function, airway responsiveness, and symptoms in children with asthma. Am Rev Respir Dis 146, 547-54, 1992.
35. Allen DB: Influence of inhaled corticosteroids on growth: a pediatric endocrinologist’s perspective. Acta Paediatr 87, 123-9, 1998.
36. Russel G: Asthma and growth. Arch Dis Child 69, 695-8, 1993.
37. Allen DB, Mullen M, Mullen B: A meta analysis of the effect of oral and inhaled corticosteroids on growth. J All Clin Immunol 93, 967-76, 1994.
38. Silverstein AU, Yunginger JW, et al: Attained adult height after childhood asthma: effect of glucocorticoid therapy. J All Clin Immunol 99, 466-74, 1997.
39. Kalberg J, Gelander L, Albertsson-Wikland K: Distinctions between short and long term human growth studies. Acta Pediatr 83, 631-4, 1993.
40. Doull IJM, Campbell MJ, et al: Duration of growth suppressive effects of regular inhaled corticosteroids. Arch Dis Child 78, 172-3, 1998.
41. Boot AM, de Jongste JC, et al: Bone mineral density and bone metabolism of prepuberal children with asthma after long-term treatment with inhaled corticosteroids. Pediatr Pneumol 24, 379-84, 1997.
42. Law CM, Honour JW, et al: Nocturnal adrenal suppression in asthmatic children taking inhaled beclomethasone dipropionate. Lancet i, 942, 1986.
43. Zwaan CM, Odinik RJH, et al: Acute adrenal insufficiency after discountinuation of inhaled corticosteroid therapy. Lancet 340, 1289-90, 1992.
44. Turpeinem M, Sovra R, et al: Change in carbohydrate and lipid metabolism in children with asthma inhaling budesonide. J All Clin Immunol 88, 384-9, 1991.
45. Cumming RG, Mitchell P, et al: Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 337, 8-14, 1997.
46. Choong K, Zwaigenbaum L, et al: Severe varicella after low dose inhaled corticosteroids. Ped Inf Dis J 14, 809-11, 1995.
47. Cotton AMJ: Severe chickenpox after intranasal use of corticosteroids. J Pediatr 123, 577-9, 1993.
48. Nursoy MA, Bakir M, et al: The course of chickenpox in asthmatic children receiving inhaled budesonide. Ped Infect Dis J 16, 74-5, 1997.
49. Ellul-Micallef R, Johansson SA: Acute dose- response studies in bronchial asthma with a new corticosteroid, budesonide. Br J Clin Pharmac 15, 419-22, 1983.
50. Wilson NM, Silverman M: Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. Arch Dis Child 65, 407-410, 1990.
51. Youngchaiyud P, Maranetra N, et al: Can inhaled steroids replace oral therapy after an acute asthma attack? Eur Respir J 9 (suppl), S23, 3, 1996.
52. Brunette MG, Lands L, et al: Childhood asthma: prevention of attacks with shortterm corticosteroid treatment of upper respiratory tract infection. Pediatrics 81, 624-29, 1988.
53. Connet G, Lenney W: Prevention of viral induced asthma attacks using inhaled budesonide. Arch Dis Child 68, 85-7, 1993.
54. Svedmyr J, Nyberg E, et al: Intermittent treatment with inhaled steroids for deterioration of asthma due to upper respiratory tract infections. Acta Paediatr 84, 884-8, 1995.