We studied the usefulness of 18 weeks of
therapy with two high doses of inhaled
beclomethasone dipropionate (BDP) in the management of severe
asthma in adults. The patients had
asthma symptoms that had not been controlled by combination
therapy with BDP (800 micrograms/day) and
bronchodilators. They were divided into two groups. Patients in group A (n = 16) were treated with 1800 micrograms/day of BDP and
bronchodilators. Patients in group B (n = 10) were treated with 1400 micrograms/day of BDP and
bronchodilators. BDP was inhaled via a large spacer (Volumatic). Eleven patients in group A and 6 patients in group B had been given an oral
steroid regularly before the study.
Asthma symptom scores, peak expiratory flow (PEF), pulmonary function, bronchial reactivity to
methacholine, the total amount of oral
steroid, and adrenocortical function were recorded. Results. 1) Clinical characteristics before the start of the study did not differ between groups. 2)
Asthma symptom scores decreased to a greater extent in patients who received the higher dose of BDP than in those who received the lower dose. 3) Only the higher dose of BDP significantly increased evening and morning % PEF, as measured 6 weeks and 8 weeks after the start of the treatment. 4) Only the higher dose of BDP significantly increased the FEV1 and the PC20 for
methacholine. FVC did not increase. 5) Only the higher dose of BDP significantly decreased the total amount of oral
steroid needed to control
asthma. 6) Results of the rapid
ACTH test indicated that neither dose of BDP suppressed adrenocoritical function. Furthermore, the serum
cortisol level measured early in the morning increased to within the normal range in the three patients in whom oral
steroid therapy could be reduced or stopped
after treatment. These data indicate that 1800 micrograms of BDP per day is more effective than 1400 micrograms/day at the beginning of long-term management of severe chronic
asthma in adults whose symptoms are not controlled with the combination of 800 micrograms/day BDP and
bronchodilators.
Therapy with a higher dose (at least 1600 micrograms/day) of an inhaled
steroid is more useful and should be promptly begun to treat severe
asthma.