Particle size of inhaled corticosteroids: Does it matter?

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A question with respect to asthma therapy revolves around the issue of whether better efficacy occurs with an ultrafine-particle inhaled corticosteroid because of better lung deposition into the distal airways. This article reviews particle size and delivery devices of different steroids, clinical outcomes of small- versus large-particle steroids, and the issue of pharmacoeconomics.

Section snippets

Particle size and delivery device differences of inhaled corticosteroids

Asthma is known to be a disease of the entire respiratory tract, including the large, intermediate, and small airways. It has been clearly shown that inflammation, obstruction, and remodeling occur throughout the respiratory tract.1 This is true for mild, moderate, and severe asthma, and although the severity can change with the classification of asthma, processes like inflammation occur in small airways, even in subjects with mild asthma.2 It is of importance to note that natural allergens,

ICS therapy: small versus large particles

Although ICSs are effective for the treatment of asthma, unfortunately, regular use of ICSs will not ensure total control of the disease in all patients.17 Furthermore, ICS use has been associated with a variety of systemic and upper airway side effects that limit regular use.18 Improving the clinical efficacy and decreasing the safety concerns of ICSs would be an extremely useful step in enabling more effective asthma control. There are 2 possible ways to improve the risk/benefit profile of

Pharmacoeconomics of particle size

The National Asthma Education and Prevention Program Expert Panel Report 3 and Global Initiative for Asthma guidelines and the US Food and Drug Administration recommendations favoring ICS monotherapy to initiate treatment in patients with persistent asthma are based on an evidence-based evaluation of a large body of clinical data using clinical and physiologic outcomes. Several pharmacoeconomic analyses support the validity of this approach and raise economic concerns about unnecessary

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  • Cited by (0)

    Supported by an unrestricted grant from Teva Respiratory, LLC.

    Disclosure of potential conflict of interest: C. Leach is a consultant for Teva Pharmaceuticals. G. L. Colice is a speaker, consultant, and board member of GlaxoSmithKline, Boehringer Ingelheim, Pfizer, Lilly, Almirall Forest, and Teva Pharmaceuticals; has provided expert witness testimony on a patent on nebulized budesonide; and has had numerous dealings with the American College of Chest Physicians. A. Luskin is the owner of Healthy Airways; is a consultant for Merck, Genentech, and Meda; has received research support from Genentech/Novartis; and has consulted for AstraZeneca, Schering-Plough, and SRxA.

    Reprint requests: Richard J. Martin, MD, National Jewish Health, 1400 Jackson St, Denver, CO 80206. E-mail: [email protected].

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