Vidyya Medical News Service
Volume 5 Issue 281 Published - 14:00 UTC 08:00 EST 8-Oct-2003 Next Update - 14:00 UTC 08:00 EST 9-Oct-2003
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Asthma drug has fewer side effects

A safer treatment for preventing asthma attacks will become available next year. It is hoped ciclesonide will be particularly useful in treating children.

Most people with asthma currently taking a preventative treatment use an inhaler containing a corticosteroid.

Inhaled steroids are very effective but can cause side effects - particularly at higher doses. Most of the drug is breathed down into the lungs where it works on inflamed lung tissue. But inevitably some will be left behind in the mouth where it can cause oral candidiasis (thrush) or sore throat and hoarseness. Some of the drug is also be swallowed and absorbed into the bloodstream where it can cause problems, such as cataracts, bone weakening and growth retardation in children.

Ciclesonide is also a steroid but only becomes active when it reaches the lung. Any left behind in the mouth or swallowed remains inactive.

Latest results on the use of the drug were presented at the European Respiratory Society meeting in Vienna this week.

Researchers carried out two studies comparing it with budesonide - a commonly used conventional inhaled steroid. One study showed ciclesonide to be more effective at improving the functioning of the lungs.

The other showed it had no effect on the body's production of cortisol, an indicator that the steroid was having no effect outside the lung. Budesonide was shown to significantly suppress the production of cortisol.

The researchers say larger trials currently underway are likely to show fewer problems such as thrush, hoarseness and wider effects on the body.

Better compliance

David Price is a GP and professor of primary care respiratory medicine at the University of Aberdeen. He said: "We have to remember that for most patients inhaled steroids are very safe but compliance is poor.

"A drug with fewer side effects like thrush will hopefully mean many more patients are able to use preventative treatment."

Professor Ronald Dahl, ERS president, said: "We know that every patient with persistent asthma should be using an inhaled steroid. But in Europe only about 25% do - while in the US it's even worse at about 15%. There is a real need for safer, effective treatments."

He said although the question of growth retardation in children is controversial it now seems likely that children who take inhaled steroids miss one or two centimetres growth.

But he added: "But you have to ask yourself does it matter if their asthma is being kept under control."

The manufacturers say the ciclesonide will be known as Alvesco when launched and results will be released soon showing it to be equally effective as other common inhaled steroids such as fluticasone (Flixotide (UK) or Flovent (US)).

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