(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Candidiasis--Oral

To determine the clinical effectiveness of pressurised metered dose inhalers (with or without spacer) compared with other hand held inhaler devices for the delivery of corticosteroids in stable asthma.. Systematic review of randomised controlled trials.. Cochrane Airways Group trials database (Medline, Embase, Cochrane controlled clinical trials register, and hand searching of 18 relevant journals), pharmaceutical companies, and bibliographies of included trials.. All trials in children or adults with stable asthma that compared a pressurised metered dose inhaler with any other hand held inhaler device delivering the same inhaled corticosteroid.. 24 randomised controlled trials were included. Significant differences were found for forced expiratory volume in one second, morning peak expiratory flow rate, and use of drugs for additional relief with dry powder inhalers. However, either these were within clinically equivalent limits or the differences were not apparent once baseline characteristics had been taken into account. No significant differences were found between pressurised metered dose inhalers and any other hand held inhaler device for the following outcomes: lung function, symptoms, bronchial hyper-reactivity, systemic bioavailability, and use of additional relief bronchodilators.. No evidence was found that alternative inhaler devices (dry powder inhalers, breath actuated pressurised metered dose inhalers, or hydrofluoroalkane pressurised metered dose inhalers) are more effective than the pressurised metered dose inhalers for delivery of inhaled corticosteroids. Pressurised metered dose inhalers remain the most cost effective first line delivery devices.

Topics: Adult; Androstadienes; Asthma; Beclomethasone; Candidiasis, Oral; Child; Fluticasone; Glucocorticoids; Hoarseness; Humans; Hydrocortisone; Nebulizers and Vaporizers; Peak Expiratory Flow Rate; Randomized Controlled Trials as Topic; Treatment Outcome

Beclomethasone dipropionate has now been used for more than 10 years during which our knowledge of how to use inhaled corticosteroids has gradually improved: high dose initial treatment followed by progressive reduction down to the minimum effective dosage; administration in 2 daily doses when the asthma is stable and 4 daily doses in case of instability; mild and transient undesirable effects, often minimized by a correct use of the inhaler; effectiveness assessed from bronchial hyper-reactivity and respiratory function tests, reduction or avoidance of oral corticosteroid therapy, or results of association with other treatments, and in particular bronchodilators. When exactly should inhaled corticosteroid therapy should be started and how long should it be pursued are controversial points, but an early and prolonged treatment must probably be recommended.

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Adult; Asthma; Beclomethasone; Bronchial Hyperreactivity; Candidiasis, Oral; Drug Therapy, Combination; Humans; Pituitary-Adrenal System

Topically active inhaled corticosteroid (IC) drugs are highly effective for chronic asthma. Formalized conceptions of "high, low or safe" dosages of these drugs may be less appropriate than one of "optimal dosage". It seems reasonable to formulate a specific goal of treatment, and then fit dosage to the individual needs and tolerances of the patient rather than to a conventionalized "safe" limit, based on averaged data from different and perhaps quite dissimilar subjects. The studies reviewed here illustrate some principles applicable to the effective use of IC drugs.

Topics: Aerosols; Asthma; Beclomethasone; Budesonide; Candidiasis, Oral; Dose-Response Relationship, Drug; Drug Administration Schedule; Glossitis; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Prednisone; Pregnenediones; Respiratory Therapy; Risk; Time Factors; Voice Disorders

The incidence of thrush occurring among patients receiving inhaled corticosteroids as reported by various investigators is presented. The data were standardized according to diagnostic criteria, duration of treatment and size of patient population. Although proper assessment of the relative risk of thrush incurred with the use of aerosolized corticosteroids must await large-scale randomized, blind, comparative trials, these results of past studies give a general indication of what may be expected.

Topics: Administration, Intranasal; Adrenal Cortex Hormones; Aerosols; Beclomethasone; Candida albicans; Candidiasis, Oral; Humans; Triamcinolone Acetonide

Topics: Adrenal Glands; Adrenal Insufficiency; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Child; Child, Preschool; Drug Evaluation; Growth; Humans; Hydrocortisone; Methylprednisolone

Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur.. To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis.. The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter.. The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids.. Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.

Topics: Administration, Inhalation; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Androstadienes; Anti-Inflammatory Agents; Antifungal Agents; Asthma; Beclomethasone; Candidiasis, Oral; Dose-Response Relationship, Drug; Drug Hypersensitivity; Female; Fluticasone; Glucocorticoids; Humans; Japan; Male; Middle Aged; Regression Analysis; Statistics as Topic; Treatment Failure

We compared the effects of increasing doses of beclomethasone dipropionate (BDP) and fluocortin butylester (FCB) on several indices of pituitary-adrenal function in healthy adult subjects. Significant depression of urinary free cortisol excretion and the response to metyrapone was seen only at the highest dose (1600 mg/day) of BDP. This depression was not reflected by frequent measurement of the serum cortisol concentration. FCB used well in excess of its presumed therapeutic dose range showed no evidence of any effect on pituitary-adrenal function. These results confirm that at high doses BDP causes pituitary adrenal suppression. Differences from studies showing reduced adrenal function in children on BDP doses of 400 to 800 mg/day probably reflect differences in the dose per kilogram of body weight. Since the use of FCB was not accompanied by any adverse side effects or evidence of reduced pituitary-adrenal function, it may be a variable alternative for asthmatics who require high doses of inhaled glucocorticoid.

Topics: Administration, Intranasal; Adult; Beclomethasone; Candidiasis, Oral; Cortodoxone; Dose-Response Relationship, Drug; Fluocortolone; Glucocorticoids; Humans; Hydrocortisone; Male; Metyrapone; Pituitary-Adrenal System; Time Factors

Sixty-seven asthmatic individuals treated with either beclomethasone diproprionate or flunisolide were sequentially evaluated for up to 32 months to determine the incidence of oropharyngeal candidiasis as well as laboratory parameters which might be predictive of this complication. Throat cultures and measurements of Candida antibody by immunodiffusion and radioimmunoassay were performed and compared over time and treatment groups. Unlike other studies, pre-treatment Candida precipitins did not predict increased risk for clinical thrush nor did quantitative determinations of Candida antibody. Those patients with positive cultures pre-trial, however, had a significantly higher incidence of clinical thrush than those with negative cultures (P less than 0.01). No significant changes occurred over time or between drugs for any of the parameters. Symptomatic thrush, however, was slightly more common in those patients treated with beclomethasone.

Topics: Adolescent; Adult; Aerosols; Aged; Antibodies, Fungal; Asthma; Beclomethasone; Binding Sites, Antibody; Candida; Candidiasis, Oral; Female; Fluocinolone Acetonide; Humans; Male; Middle Aged; Nystatin; Risk

Topics: Adrenal Cortex Hormones; Aerosols; Asthma; Beclomethasone; Candidiasis; Candidiasis, Oral; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Nystatin; Respiratory Tract Infections; Time Factors; Voice Disorders

A follow-up study to 52 weeks is reported on 95 corticosteroid-dependent asthmatics who took part in a double-blind, controlled trial of beclomethasone dipropionate for 28 weeks. During the 28 weeks two dosage schedules (800 microgram and 400 microgram daily) were compared with a placebo. If the corticosteroid tablet dosage had been at least halved and the clinical condition was satisfactory, the allocated regimen was continued 'blind' for the second period (29-52 weeks); 51 patients continued for this period, 46 on beclomethasone dipropionate. If progress was unsatisfactory, known beclomethasone dipropionate 800 microgram daily was substituted, the supervision remaining unchanged, the clinical supervisors remaining unaware which schedule had been received during the first 28 weeks. Nearly all the patients who at least halved their corticosteroid tablet dosage by 28 weeks continued to do well up to 52 weeks on the allocated regimen. When the placebo patients with unsatisfactory progress at 28 weeks were changed to 800 microgram beclomethasone dipropionate they showed a substantial improvement. Patients changed from 400 to 800 microgram showed little improvement on average. Approximately 30% of the whole group of patients failed to have their dosage of corticosteroid tablets, despite receiving 800 microgram beclomethasone dipropionate daily for six or more months. The cumulative incidence of 'oral candidiasis' (as defined for this report) in placebo patients changed at 28 weeks to 800 microgram beclomethasone dipropionate daily was 30% at 36 weeks and 43% at 52 weeks. Of eight patients increased from 400 microgram to 800 microgram daily, one had 'candidiasis' by 36 weeks and three by 52 weeks. Oral candidiasis was often asymptomatic and never led to the discontinuation of the corticosteroid aerosol, although the dosage was reduced in nine of the 30 who received 800 microgram beclomethasone dipropionate during the first 28 weeks. The incidence of bacterial infections in patients on beclomethasone dipropionate was similar to that of the placebo group and systematic laboratory investigations revealed no increase in the rate of isolation of potential pathogens.

Topics: Adolescent; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Humans; Placebos; Sputum

In a 26-wk double-blind controlled study of 34 patients whose asthma had been poorly controlled despite oral steroids, valuable clinical and pulmonary function improvement was derived by adding beclomethasone aerosol to the prednisone regimen. The amount of improvement correlated linearly with beclomethasone dosage over the range 200 to 1,600 microng/day. These patients required relatively high dosage. Success in achieving asymptomatic status was only 26% with the conventional 400 microng/day and 60% at 1,600 microng/day. Oropharyngeal candidiasis was also dose-related but did not prohibit the use of high-dosage beclomethasone. Respiratory infections, physical signs, blood glucose, and electrolytes were unaffected by the drug. A dose-related suppression of cortisol secretion was demonstrated, but about 1/4 of the group had normal plasma cortisol even at 1,600 microng/day plus the oral prednisone. An individualized risk-benefit assessment seems a better basis for choosing an optimal beclomethasone regimen for each patient than adherence to a conventionalized fixed dosage of 400 microng/day. This requires definition of: (1) a specific goal of treatment in the individual patient and the beclomethasone dosage required to achieve it; (2) the adrenocortical functional response of that particular patient to the desired dose of beclomethasone; and (3) the presence and degree of any dose-limiting constraints such as preexisting complications of steroid use.

Topics: Adult; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Therapy, Combination; Eosinophils; Female; Humans; Hydrocortisone; Leukocyte Count; Male; Middle Aged; Prednisone

Forty-two perennial asthmatic children were selected for a 12-wk study using beclomethasone dipropionate. The groups included 21 steroid-dependent children (Group I) and 21 patients (Group II) whose disease was of sufficient severity that corticosteroid therapy was contemplated. All children received the drug in a dose of 100 mug 4 times daily. During the study, oral prednisone was withdrawn from the steroid-dependent children while other therapy was essentially unchanged. Group II children underwent a double-blind trial, receiving beclomethasone for 6 wk and placebo for 6 wk. Objective assessment of adrenal and pulmonary function was obtained at regular intervals. For the latter, total lung capacity and its subdivisions, airways resistance, maximum expiratory flow volume, and oxygen tension, were measured in both groups. In Group II static elastic recoil was measured also. For most tests the results were statistically significant. In both groups, 18 of 21 patients demonstrated an excellent clinical response, no evidence of adrenal suppression, and improvement in pulmonary function. Forty of 42 patients were followed for another 12 wk, and 19 of each group did well. After 20-24 wk of therapy, 16% of patients harbored monilia in their oropharynx, and 1 patient had clinical monilial stomatitis. Within the limits of the time of the study, beclomethasone dipropionate appeared to provide adequate clinical control in many chronic, severe, steroid-dependent and nonsteroid-dependent asthmatic children.

Topics: 17-Ketosteroids; Adolescent; Adult; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Child; Clinical Trials as Topic; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Respiratory Function Tests

Betamethasone valerate aerosol is a new compound for the treatment of asthma. Its clinical effectiveness was established in a double-blind cross-over trial in non-steroid-dependent asthmatic patients. At a dosage of 400 to 800 mug/day for three months there was no evidence of suppression of hypothalamic-pituitary-adrenal function, as assessed by tetracosactrin and insulin stress tests.A 12-month follow-up study of 120 patients using steroid aerosols (betamethasone valerate or beclomethasone dipropionate) indicated that tolerance does not develop and that a daily maintenance dose of 200 mug/day was adequate in most patients. Temporary lack of response was observed during episodes of sputum production or of heavy exposure to antigen.There were no observed side effects other than fungal infections of the respiratory tract. However, the incidence of candidiasis of the pharynx (13%) and particularly of the larynx (5%) in apparently immunologically normal patients was disturbing. These infections were not seen in patients taking 200 mug/day. Though there is yet no evidence that fungal infections associated with steroid aerosols may penetrate the trachea and bronchi the possibility of this indicates that caution should be exercised in their use, particularly in long-term high dosage.

Topics: Adolescent; Adrenal Glands; Adult; Aerosols; Asthma; Beclomethasone; Betamethasone; Blood Glucose; Candidiasis, Oral; Clinical Trials as Topic; Drug Tolerance; Female; Follow-Up Studies; Humans; Hypersensitivity, Delayed; Hypothalamus; Insulin; Kidney Function Tests; Laryngeal Diseases; Lymphocyte Activation; Male; Middle Aged; Pharyngeal Diseases; Pituitary Gland; Placebos; Pulmonary Ventilation

A survey of 936 patients attending a respiratory diseases unit outpatient department was performed to assess the incidence of oropharyngeal candidiasis in patients inhaling beclomethasone dipropionate in daily doses of 400 mug or less. Throat swabs from 209 (41%) patients treated with beclomethasone were positive on culture for yeasts compared with positive swabs from 77 (27.2%) patients not receiving corticosteroid therapy either orally or by inhalation. Clinical oropharyngeal thrush, confirmed by culture, was detected in 28 (5.5%) patients inhaling beclomethasone, one (0.7%) patient receiving treatment with oral prednisolone, and two (0.7%) patients not being treated with corticosteroids.

Topics: Administration, Oral; Administration, Topical; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candida; Candida albicans; Candidiasis; Candidiasis, Oral; Clinical Trials as Topic; Glucocorticoids; Humans; Pharyngeal Diseases; Pharynx; Prednisolone

Co-prescription of Aerochamber

Topics: Administration, Inhalation; Adult; Anti-Asthmatic Agents; Asthma; Beclomethasone; Candidiasis, Oral; Female; Hoarseness; Humans; Inhalation Spacers; Male; Metered Dose Inhalers; Middle Aged

The influence of dentures on residual inhaled corticosteroids (ICSs) in the mouths of elderly asthmatic patients and the appropriate time for gargling after inhaling ICSs are unclear.. Twenty elderly patients in whom moderate persistent asthma was stably controlled using fluticasone propionate Diskus (FP, n = 10) or hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP, n = 10) for more than 3 months and who wore dentures daily were switched to the other type of ICS for 4 weeks in a crossover manner. The residual amount of each ICS in their mouths after inhalation was measured along with determination of peak inspiratory flow (PIF) and pharyngeal culture for detecting Candida albicans.. The total amounts of residual ICSs in gargling fluids (μg) with HFA-BDP were significantly greater than those with FP (15.6 ± 14.6 vs. 11.5 ± 13.8, p = 0.028). The residual amounts of HFA-BDP were significantly greater in the patients with complete dentures than in those with partial dentures. The residual amounts of FP were significantly correlated with the PIF values in the FP treatment (p = 0.013) but not in the HFA-BDP treatment (p = 0.202). No residual ICSs remained after the third gargling in either treatment. The occurrence of candidiasis during the HFA-BDP period was significantly higher than that during the FP treatment (p = 0.046).. The dentures of elderly asthmatics affect the oral residues of ICSs and occurrence of candidiasis in HFA-BDP treatment; meanwhile, the PIF values affected these factors in FP treatment. Three times gargling after inhaling ICSs is required.

Topics: Administration, Inhalation; Aged; Aged, 80 and over; Androstadienes; Asthma; Beclomethasone; Bronchodilator Agents; Candidiasis, Oral; Dentures; Female; Fluticasone; Humans; Hydrocarbons, Fluorinated; Male; Mouth; Mouthwashes

In order to estimate predisposing activity of oral application of beclomethasone dipropionate (BDP)-containing mucoadhesive films for oral candidiasis, the effects of BDP on growth of Candida albicans were examined in vivo and in vitro. Murine neutrophils inhibited the mycelial growth of C. albicans in vitro, but this anti-Candida activity was clearly suppressed by the presence of 10(-6) M of BDP. In vitro, a BDP-release test showed that the amount of BDP released from BDP-containing films into the fluid phase increased in a time- and concentration-dependent manner and reached about 10-15% of the total amount of BDP in the film within 30 min. When the BDP-containing film was attached to the tongues of mice orally infected with C. albicans, oral infection by C. albicans deteriorated, but not as severely as in mice systemically immunosuppressed with prednisolone. Based on these findings, we also discuss the problems associated with the clinical application of BDP-film as an anti-inflammatory tool.

Topics: Administration, Oral; Animals; Beclomethasone; Body Weight; Candida albicans; Candidiasis, Oral; Glucocorticoids; Mice; Mice, Inbred ICR; Mycelium; Neutrophils; Tongue

We established a novel murine model of pharyngeal candidiasis maintaining stable yeast population and local symptoms characteristic of pharyngeal thrush. The persistent Candida-infection was prolonged by inhalation of beclomethasone dipropionate corticosteroid. The severity of infection lesions was evaluated by determining viable cell number of Candia albicans and scores representing symptomatic curd-like white patch on pharyngeal tissue. The utility of this model was shown by the disappearance of lesions and fungal cells after treatment with fluconazole (FLCZ). The model would be useful for evaluating new chemotherapeutic or immunotherapeutic approaches against pharyngeal candidiasis, as well as in pathological studies.

Topics: Administration, Inhalation; Animals; Antifungal Agents; Beclomethasone; Candida albicans; Candidiasis, Oral; Colony Count, Microbial; Disease Models, Animal; Female; Fluconazole; Histocytochemistry; Immunosuppressive Agents; Mice; Mice, Inbred ICR; Pharynx

Inhaled corticosteroids are used for the treatment of bronchial asthma. Systemic side effects are rare, but local problems, such as oral candidiasis, can occur. Only a proportion of patients encounter this problem, and the mechanism of oral candidiasis induced by inhaled corticosteroids remains obscure. According to reports in immunodeficient patients, oral candidiasis is related to deficiencies in topical immunity, such as salivary IgA.. We evaluated differences in salivary IgA between asthmatics in whom Candida was detected or not detected from the pharynges, respectively.. Saliva was collected from 18 healthy controls and 37 asthmatic patients treated with inhaled corticosteroids. The amounts of total IgA and the Candida-specific IgA of the saliva were measured. Fungal culture of the pharyngeal wall was also performed.. There were no differences in salivary total IgA and Candida-specific IgA between healthy controls and culture-negative asthmatic patients. Salivary total IgA of Candida-positive asthmatic patients was significantly lower than that of Candida-negative patients. However, there was no difference in Candida-specific IgA levels between these two groups.. Our results suggest that inhaled corticosteroids can potentially decrease salivary total IgA but that host factors are also important in the development of oral candidiasis.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Aged; Androstadienes; Anti-Asthmatic Agents; Antibody Specificity; Asthma; Beclomethasone; Candida albicans; Candidiasis, Oral; Female; Fluticasone; Humans; Immunoglobulin A, Secretory; Male; Middle Aged; Nebulizers and Vaporizers; Opportunistic Infections; Pharynx; Risk; Saliva

Effects of mouth wash (mouth rinsing and gargling) on the removal of drug residues in both mouth and pharynx after the use of pressurized aerosol metered-dose inhaler (MDI) were studied. The concentration of beclomethasone dipropionate (BM) in mouth wash after a splay of Becotide inhaler was measured by the method using HPLC. The total amount of the removed BM was measured by a sum of the concentrations of BM in 4 or 5 times of mouth washes in the following 4 kinds of methods. In method 1, mouth wash was done with 5 times of water change after a splay of MDI on wetted mouth. In method 2, mouth wash was done with 5 times of change water on dried mouth. In method 3, mouth wash was done with 4 times of change saliva on wetted mouth. In these methods, the actual inhalation of BM was not done. In method 4, mouth wash was done with 5 times of change water after a splay and a inhalation on wetted mouth. The mouth wash procedures removed totally 47.9%, 51.1%, 31.3%, and 33.3% of a splayed amount of BM in each method, respectively. It was required for the removal of 90% of the totally recovered BM to do one time of mouth wash in method 1, two times in method 2, three times in method 3, and two times in method 4, respectively. These data suggest that the mouth wash procedure is shown to have prophylactic benefit for candidiasis induced by steroid delivered by MDI.

Topics: Administration, Inhalation; Adult; Aerosols; Beclomethasone; Candidiasis, Oral; Chromatography, High Pressure Liquid; Female; Humans; Male; Mouthwashes

We compared the incidence of Candida infection, Candida colonization, and reduction in oral prednisone dose in patients with asthma treated with beclomethasone dipropionate delivered by metered-dose inhaler (MDI) alone and MDI plus Aerochamber. Group M contained 18 patients treated with beclomethasone, four actuations four times a day (672 micrograms/day), delivered by MDI alone. Group A contained 18 patients treated with the same dose of beclomethasone delivered by MDI plus Aerochamber. In group M, four of 18 patients had Candida infection, 12 of 18 patients had Candida colonization, and six of 18 patients were completely removed from oral prednisone. In group A, 0 of 18 patients had Candida infection (p = 0.05), six of 18 patients had Candida colonization (p less than 0.05), and 12 of 18 patients were completely removed from oral prednisone (p less than 0.05). We conclude that beclomethasone delivered by MDI plus Aerochamber is more efficacious in reducing oral prednisone dependency and produces less Candida infection and colonization than beclomethasone delivered by MDI alone.

Topics: Administration, Oral; Adult; Aerosol Propellants; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Pharyngitis; Prednisone

Topics: Administration, Buccal; Animals; Beclomethasone; Candidiasis, Oral; Immunosuppressive Agents; Male; Mice; Mice, Inbred CBA; Mouth Mucosa; Opportunistic Infections

Topics: Beclomethasone; Candidiasis, Oral; Humans; Nebulizers and Vaporizers

Mucosal candidosis was induced in CBA mice by intraoral inoculation following treatment with corticosteroid-containing aerosol (beclomethasone dipropionate). Histologically, in hormone treated mice the adherence of the pathogen to the mucosal surface was found during the first hours after inoculation. This is followed by the formation of the germ tubes and invasion in the epithelial layer. Pseudomycelial invasion in the malpighian layer is accompanied by the leukocyte response that limits the further spread of the fungal cells. In intact mice, the inoculation is not followed by the effective attachment of the fungal cells to the mucosal surface and induction of mycotic lesions. In vitro experiments have demonstrated the enhanced adherence of fungal blastospores to the epithelial cells of the hormone treated animals, that appears to be one of the mechanisms in the pathogenesis of candidosis in these animals.

Topics: Aerosols; Animals; Beclomethasone; Candidiasis, Oral; Epithelium; Male; Mice; Mice, Inbred CBA; Mouth Mucosa; Time Factors

The effects of long-term use of high-dose inhaled beclomethasone dipropionate (BDP) were studied retrospectively in 293 asthmatic patients who were not adequately controlled on conventional doses of BDP or who required oral corticosteroids to control their asthma. The higher doses of BDP were administered in a high-dose beclomethasone aerosol (BDP 250) containing 250 micrograms BDP per metered dose. 27% of the steroid-dependent asthmatics were able to stop oral steroids altogether after the introduction of BDP 250, and a further 39% were able to reduce their daily dosage. Improvement in asthma control was achieved in 62% of all patients and was accompanied by a reduction in the number of severe acute exacerbations and a significant increase in mean peak expiratory flow rate. Oropharyngeal candidiasis was not significantly more common with the BDP 250 inhaler than with conventional inhalers and appears to have been related to the number and frequency of inhalations and not solely to the total dosage. Other side-effects were very rare.

Topics: Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Drug Therapy, Combination; Female; Humans; Male; Prednisolone; Respiratory Therapy; Retrospective Studies; Time Factors

Topics: Aerosols; Aged; Asthma; Beclomethasone; Candidiasis, Oral; Humans

Experience with beclomethasone dipropionate during the past 5 years has confirmed and extended the original observation that it is an effective, topically active corticosteroid of great value in treating asthma. Most steroid-dependent asthmatic patients can be successfully controlled with the drug, at least most of the time, and the therapeutic effect is dose dependent. Although high doses may be associated with some adrenal suppression such doses do not cause systemic symptoms, and side effects are of little consequence. It is important that patients treated with steroid aerosols continue to receive other effective therapeutic agents, notably adrenergic drugs, particularly by aerosol, and theophylline compounds; that they learn how to inhale the aerosol properly; and, most important, that they promptly start taking oral steroids when they experience an exacerbation of asthma.

Topics: Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Humans; Long-Term Care; Lung Diseases, Obstructive

Inhaled beclomethasone dipropionate (BDP) has proved to be an effective corticosteroid in the treatment of asthma, acting as if it were equivalent to about 5 to 10 mg of prednisolone per day but without the systemic side effects that may accompany oral treatment. The effectiveness of inhaled BDP is not associated with significant local side effects, the most common of which has proved to be oral candidiasis. There is no evidence to date that inhaled BDP promotes lung infection or damages the bronchial epithelium.

Topics: Asthma; Beclomethasone; Candidiasis, Oral; Humans; Prednisolone; Respiratory Therapy

Topics: Adrenal Insufficiency; Asthma; Beclomethasone; Candidiasis; Candidiasis, Oral; Child; Humans; Pharyngeal Diseases

A prospective study of forty adult asthmatic patients attending two chest clinics in the City of Liverpool was undertaken. All patients had reversible airways obstruction and were under treatment with either beclomethasone dipropionate or sodium cromoglycate. Satisfactory symptomatic control was achieved in both groups of patients on a subjective basis, but there was a statistically significant (P less than 0-001) reduction in the number of admissions to hospital in the treatment year compared to the preceding 12 months in the beclomethasone aerosol group. No increased incidence of lower respiratory tract infections or non-specific sore throats was found in either group studied. No cases of clinical oral Candida infection occurred in the beclomethasone aerosol treated patients. It is concluded that beclomethasone dipropionate in aerosol form is not only a safe and effective method for symptomatic control of adult bronchial asthma but is also economically worthwhile as a means of reducing hospital admissions in this vulnerable group of patients.

Topics: Adult; Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Cromolyn Sodium; Female; Hospitalization; Humans; Lung Diseases; Male; Middle Aged; Pharyngitis; Prospective Studies; Respiratory Tract Infections

In a survey of 400 consecutive patients with chronic asthma treated with beclomethasone dipropionate aerosol (up to 400 mug/day) the prevalence of oropharyngeal thrush was 4-5%. The prevalence of this complication was not significantly related to sex, age, duration of treatment with beclomethasone or concurrent treatment with prednisolone. Yeasts were isolated from throat swabs in about 60% of all patients and in 48% of normal controls. Thus, although a diagnosis of oropharyngeal thrush was recorded only when the presence of characteristic lesions in the pharynx was associated with a positive culture, there was a large number of patients and controls without thrush who harboured yeasts in the throat. One in 3 patients with thrush complained of sore throat or hoarseness, but 1 in 4 patients without thrush had similar symptoms. These findings suggest that, although treatment with beclomethasone dipoprionate aerosol undoubtedly can cause oropharyngeal thrush, this condition is not an inevitable result of colonization of the oropharynx by yeasts, nor is it necessarily associated with symptoms.

Topics: Adolescent; Adult; Aerosols; Aged; Asthma; Beclomethasone; Candida; Candidiasis, Oral; Female; Humans; Male; Methylprednisolone; Middle Aged; Mouth; Pharyngeal Diseases; Pharynx; Prednisolone

Topics: Beclomethasone; Candidiasis, Oral; Humans; Methylprednisolone; Pharynx; Prednisolone

Topics: Aerosols; Asthma; Beclomethasone; Candidiasis, Oral; Humans; Intestinal Absorption; Methylprednisolone; Pituitary-Adrenal Function Tests; Prednisolone

Topics: Administration, Topical; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candidiasis, Oral; Chronic Disease; Glucocorticoids; Humans; Prednisone