scholarly journals Ciclesonide in the Management of Asthma

2009 ◽  
Vol 1 ◽  
pp. CMT.S2133
Author(s):  
Daniel Gonzalez ◽  
Hartmut Derendorf
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
Inhaled Corticosteroids ◽  
Parent Compound ◽  
Persistent Asthma ◽  
Hepatic Clearance ◽  
Dose Inhaler ◽  
First Line Therapy ◽  
Pharmacodynamic Profile ◽  
Metered Dose

Ciclesonide is a novel inhaled corticosteroid (ICSs) approved in most countries for the management of persistent asthma. Although inhaled corticosteroids are first-line therapy in the treatment of asthma, long term use and high-doses of these products may result in significant side effects. When developing a new ICSs, the goal is to identify a drug with comparable (or superior) efficacy to active comparators, and an improved safety profile. Ciclesonide is a prodrug which is administered through a hydrofluoroalkane-propellant metered dose inhaler (HFA-MDI). Once it reaches the lungs, the parent compound is metabolized by esterases to desisobutyryl ciclesonide (des-CIC), an active metabolite with a 100-fold greater affinity for the glucocorticoid receptor. Ciclesonide has a unique pharmacokinetic-pharmacodynamic profile which confers an improved therapeutic ratio. Several clinical trials have shown that its efficacy is superior to placebo and similar to several active comparators. However, its high pulmonary deposition and on-site activation minimizes the risk for local side effects. Also, its low oral bioavailability, high hepatic clearance, and extensive plasma protein binding, among other factors, decrease the risk for systemic side effects. Doses of ciclesonide as high as 1280 μg/day (ex-actuator) result in minimal hypothalamic-pituitary-adrenal (HPA) axis suppression, a measure commonly used to assess systemic bioavailability for an ICSs. This review will provide a summary of ciclesonide's role in the management of asthma, including a discussion of relevant clinical trials designed to evaluate its efficacy and safety.

scholarly journals Inhaled Drug Delivery: A Practical Guide to Prescribing Inhaler Devices

1998 ◽  
Vol 5 (3) ◽  
pp. 180-183 ◽  
Author(s):  
Pierre Ernst
Keyword(s):  
Drug Delivery ◽  
Inhaled Corticosteroids ◽  
High Ratio ◽  
Dose Inhaler ◽  
Breath Hold ◽  
Major Drawback ◽  
Inhalation Devices ◽  
Systemic Bioavailability ◽  
Metered Dose ◽  
Residual Capacity

Direct delivery of medication to the target organ results in a high ratio of local to systemic bioavailability and has made aerosol delivery of respiratory medication the route of choice for the treatment of obstructive lung diseases. The most commonly prescribed device is the pressurized metered dose inhaler (pMDI); its major drawback is the requirement that inspiration and actuation of the device be well coordinated. Other requirements for effective drug delivery include an optimal inspiratory flow, a full inspiration from functional residual capacity and a breath hold of at least 6 s. Available pMDIs are to be gradually phased out due to their use of atmospheric ozone-depleting chlorofluorocarbons (CFCs) as propellants. Newer pMDI devices using non-CFC propellants are available; preliminary experience suggests these devices greatly increase systemic bioavailability of inhaled corticosteroids. The newer multidose dry powder inhalation devices (DPIs) are breath actuated, thus facilitating coordination with inspiration, and contain fewer ingredients. Furthermore, drug delivery is adequate even at low inspired flows, making their use appropriate in almost all situations. Equivalence of dosing among different devices for inhaled corticosteroids will remain imprecise, requiring the physician to adjust the dose of medication to the lowest dose that provides adequate control of asthma. Asthma education will be needed to instruct patients on the effective use of the numerous inhalation devices available.

Headliner in Physiology and Management of Childhood Asthma: Hypothalamic-Pituitary-Adrenal Axis

2020 ◽  
Vol 16 (1) ◽  
pp. 43-52 ◽  
Author(s):  
Nese Akcan ◽  
Nerin N. Bahceciler
Keyword(s):  
Side Effects ◽  
Hpa Axis ◽  
Inhaled Corticosteroids ◽  
Cushing Syndrome ◽  
Early Recognition ◽  
Persistent Asthma ◽  
Receptor Expression ◽  
Hypothalamic Pituitary Adrenal

Asthma is the most common chronic inflammatory disease of children. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy which are the most effective, commonly used treatment of persistent asthma. Mostly, studies on the relationship between asthma and cortisol have focused on side effects of treatment. Recently, asthmatic patients not treated with ICS have been reported to have an attenuated activity and/or responsiveness of their Hypothalamic-Pituitary- Adrenal (HPA) axis. Moreover, it has been proposed that asthma worsening with stress may be due to a dysfunctional HPA axis, or cortisol insensitivity due to chronic psychological stress through impaired glucocorticoid receptor expression or function. Although long-term ICS treatment might produce adrenal suppression or iatrogenic Cushing syndrome, improvement of adrenal function has also been detected in some of asthmatic cases. Thus, the response scheme of HPA axis still contains undiscovered features in asthma. The management of asthma can be improved by increasing knowledge on the role of HPA axis in asthma pathophysiology. The risk for side effects of ICS can be minimized through increased awareness, early recognition of at-risk patients and regular patient follow-up. This review was written to draw attention to the role of HPA axis in both asthma and its treatment and to illustrate a follow up algorithm of HPA axis in the management of asthma.

scholarly journals Measurement of Inhaled Corticosteroid Adherence in Inner-City, Minority Children with Persistent Asthma by Parental Report and Integrated Dose Counter

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Marina Reznik ◽  
Philip O. Ozuah
Keyword(s):  
Clinical Practice ◽  
Persistent Asthma ◽  
Dose Inhaler ◽  
Alternative Measure ◽  
Parental Report ◽  
Inhaled Corticosteroid ◽  
Minority Children ◽  
Treatment Regimens ◽  
Adherence Assessment ◽  
Metered Dose

Parents often overreport adherence to asthma treatment regimens making accurate assessment of medication adherence in clinical practice difficult. This study was conducted to compare two adherence assessment methods clinicians may choose from when assessing patient inhaled corticosteroid (ICS) adherence: parental report and dose counter measurements of metered-dose inhaler (MDI) actuation. Participants included children (N=50) with persistent asthma and their parents (N=50). At enrollment, children received a new, marked ICS at the dose prescribed by their physician. Thirty days following enrollment, we measured ICS adherence by parental report and objectively, with a dose counter. Parental report overestimated ICS adherence when compared to dose counter. We found a statistically significant overall difference between parental report and objectively measured adherence. A dose counter that most ICS inhalers are equipped with may be a more reliable alternative measure of ICS adherence in a clinical practice setting.

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