Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Bon Secours Hospital, Consultants Clinic, Glasnevin, Dublin, Ireland, 9.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; 16(2):CD007031. DOI: 10.1002/14651858.CD007031
Source: PubMed


Inhaled corticosteroids, such as budesonide, beclomethasone or fluticasone, which have been available for many years, have proven to be an important therapy for controlling the inflammation caused by asthma. They are given usually twice daily, and are recommended therapy in international guidelines for most asthmatics. However, the currently available inhaled corticosteroids can be associated with significant side-effects, including local effects in the upper airways such as hoarseness and oral candida (thrush infection). Ciclesonide is a new steroid which is reported to make less of the active steroid available until the drug reaches the lung on inhalation, which could reduce the likelihood of throat symptoms. This findings of this review of 21 trials (7243 participants) do not allow certainty about the relative efficacy of ciclesonide compared to older inhaled corticosteroids, especially at higher doses. The results of the review to date do not indicate whether ciclesonide provides a significantly more useful safety profile that other inhaled corticosteroids at similar equivalent doses. However, the finding of lower oral candidiasis in patients treated with ciclesonide compared to fluticasone may be important for those patients who experience oral thrush with their current ICS. In addition, further studies in children are required to obtain data on the side-effect profile of ciclesonide in this population.

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Available from: Patrick J Manning, Jan 06, 2014
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    • "A randomised controlled, double-blind, double-dummy clinical trial in school children aged 5–12 years with mild–moderate asthma showed that ultrafine HFA-BDP MDI and CFC-fluticasone MDI were equally effective in improving asthma control in children with mild–moderate asthma at the same daily dose and that the majority of children in both groups could reduce their daily dose to as low as 50 μg/day while maintaining good asthma control [66]. In 2008, a Cochrane Systemic Review compared ciclesonide with other inhaled corticosteroids in children and adults with asthma [48]. The majority of the studies were performed in asthma patients from 12 to 75 years of age. "
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    ABSTRACT: Inhaled corticosteroids (ICS) are the most effective anti-inflammatory drugs for the treatment of persistent asthma in children. Treatment with ICS decreases asthma mortality and morbidity, reduces symptoms, improves lung function, reduces bronchial hyperresponsiveness and reduces the number of exacerbations. The efficacy of ICS in preschool wheezing is controversial. A recent task force from the European Respiratory Society on preschool wheeze defined two different phenotypes: episodic viral wheeze, wheeze that occurs only during respiratory viral infections, and multiple-trigger wheeze, where wheeze also occurs in between viral episodes. Treatment with ICS appears to be more efficacious in the latter phenotype. Small particle ICS may offer a potential benefit in preschool children because of the favourable spray characteristics. However, the efficacy of small particle ICS in preschool children has not yet been evaluated in prospective clinical trials. The use of ICS in school children with asthma is safe with regard to systemic side effects on the hypothalamic-pituitary-adrenal axis, growth and bone metabolism, when used in low to medium doses. Although safety data in wheezing preschoolers is limited, the data are reassuring. Also for this age group, adverse events tend to be minimal when the ICS is used in appropriate doses.
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    Cochrane database of systematic reviews (Online) 02/2008; 4(4):CD002173. DOI:10.1002/14651858.CD002173.pub2 · 6.03 Impact Factor
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