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Childhood asthma data highlights potential role of drug delivery in 'stepping down' potency of inhal

Added: (Fri Dec 08 2000)

Pressbox (Press Release) - Issue date: Friday, 1st December 2000

New prospects of obtaining asthma control in paediatrics with lower doses compared with conventional inhaled steroids highlight the role of effective delivery, not just dose strength, in achieving the recommended ‘stepwise’ approach to asthma management.

Considering ‘New Concepts for Managing Paediatric Asthma’ at the European Conference on Paediatric Asthma in London today , Professor John Price, Professor of Paediatric Respiratory Medicine, Kings College Hospital, said “Drug delivery is an important aspect of effective asthma control in children."

“The effectiveness of an inhaled steroid is influenced by its distribution throughout the bronchial tree," he explained. “Now, the emerging paediatric data on new formulations of existing inhaled therapies is suggesting that improved delivery has the potential to allow for dose reductions whilst maintaining symptom control.”

"The primary aim when treating asthmatic children with an inhaled steroid is to achieve asthma control with the lowest possible dose. When "stepping down" treatment - according to the BTS guidelines - it is important to consider both the drug and the delivery device."

Professor Price was commenting on a review of recent paediatric studies suggesting that improved deposition and distribution throughout the airways could be a key factor in obtaining control of childhood asthma at lower doses123,6.

Authors of recent paediatric studies of the Qvar Autohaler™, which delivers the established steroid beclomethasone dipropionate (BDP) in an extra-fine, hydrofluoroalkane – 134a (HFA – 134a) formulation , highlighted the management implications emerging from the work.

Comparing published data on lung deposition of current aerosol devices, Dr S Devadason, of University of Western Australia, Perth, found that with this new formulation the lung deposition increased - 41.1per cent to 53.5 per cent in 5-14-year-olds - compared with reported values from other inhaled steroids.
Looking at particle size and deposition, she reported that these resulted in more drug delivered to the airways of children aged 5-14 than with other inhalers7,8., and estimated it would take lower doses of Qvar to achieve the same improvements in lung function compared with conventional BDP. 9

“The potential implications for appropriate low dose prescribing are very interesting,” said Dr Sunalene Devadason. “The fine formulation appeared to reduce the oropharyngeal deposition and increase the lung deposition without the need for a spacer, which tends to be required with coarser aerosols.”

Professor Ulrich Wahn, of the Paediatric Clinic of Pneumology and Immunology, Berlin, reinforced the increased scope that may be offered by improved delivery in balancing control with the lowest possible dose.

“The guidelines recommend a stepwise approach to dosing and stress to us the need to balance efficacy with safety by giving the lowest dose compatible with asthma control,” he said. “We have dose recommendations for traditional inhaled steroids, but what about the newer formulations?

“Once we saw the improved deposition 1, we wanted to test the hypothesis that by improving efficiency of inhaled steroid delivery to both the large and small airways, you could lower the dose to achieve a similar or improved effect on lung function and other markers of asthma control. Our long-term data on safety and efficacy of HFA-BDP [Qvar™] confirmed our predictions.”

He found asthma control was maintained in boys, aged 5-11, and girls, aged 5-10, when switched from conventional BDP to a lower dose of Qvar™ (HFA-BDP) over six and 12 months.2

"This symposium has addressed the question "Does better deposition and distribution of inhaled steroid in the lung airways allow us to achieve asthma control in children at a lower dose" said Professor John Price

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Alexa Forbes
Packer Forbes, tel: 020 8772 1551

Editors Notes

? Qvar™ is currently indicated in the UK for the prophylactic management of mild, moderate or severe asthma for adults and children aged 12 and over. An application has been filed with the MCA for its use in children aged 5 and over.

? Qvar Autohaler™ is made by 3M Health Care, the company which pioneered the metered-dose inhaler (MDI) technology 40 years ago – an innovation that has become a mainstay of respiratory medicine, allowing rapid delivery of medication at low doses directly to the lung.

? 3M Health Care research and development focuses on respiratory disease and drug delivery systems. The company is also involved in cardiac arrhythmia and angina, restorative dentistry and sexual health, providing surgical devices, hospital and community medical products as well as diagnostics to the UK healthcare industry.

? The company is part of the multinational 3M organisation, headquarted in Minnesota, US, with operations in over 60 countries specialising in science and technology-based innovation.

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