Fluticasone via Diskus inhaler deemed better than budesonide via Turbuhaler

NEW YORK (Reuters Health) – Results of a randomized trial in asthmatic adults indicate that fluticasone administered by Diskus inhaler is as effective as twice the dose of budesonide via Turbuhaler inhaler, and causes less hypothalamic-pituitary-adrenal axis suppression. Patients also rated the Diskus inhaler more highly than the Turbuhaler inhaler, researchers report.

Dr. R. K. Sharma from GlaxoSmithKline Research and Development, Stockley Park, UK, and colleagues randomized 227 asthmatic patients, 18 to 87 years of age, to fluticasone 250 µg twice daily, delivered through a Diskus inhaler, or to budesonide 600 µg twice daily delivered through a Turbuhaler inhaler. The Diskus inhaler is manufactured by GlaxoSmithKline.

During the 4 weeks of the trial there was no significant difference between the two regimens in morning or evening peak expiratory flow or any other efficacy measure, the researchers report in the November issue of Clinical Drug Investigations.

There was a significant difference in mean morning serum cortisol levels, with patients receiving fluticasone having higher values, 359 nmol/L versus 278 nmol/L for patients receiving budesonide. "The ratio of fluticasone-adjusted cortisol mean to budesonide-adjusted cortisol mean was 1.29 nmol/L (p < 0.001)," Dr. Sharma's team notes.

Dr. Sharma and colleagues note that "these results are consistent with previous studies and do not depend on the delivery device by which the drugs are administered."

Patients did find the Diskus inhaler easier to use than the Turbuhaler inhaler. Eighty-one percent of the patients were able to use the Diskus inhaler correctly the first time compared with 61% of those using the Turbuhaler inhaler. At the end of the trial, 98% of those using the Diskus inhaler were using it correctly compared with 90% of those using the Turbuhaler inhaler, according to the report.

Clin Drug Invest 2001;21:735-743.

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