(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

Esophageal candidiasis is one of the local side effects of inhaled corticosteroid treatment, and it is difficult to prevent this condition. Our previous report indicated that the prevalence of esophageal candidiasis among patients treated with inhaled fluticasone propionate dry powder (FP-dp) reached up to 37% in Japanese patients. Although a reduction in the daily dose of inhaled FP-dp can eliminate this infection, it may lead to asthma not being well-controlled in these patients.. The aim of this study was to estimate whether switching to an equal daily dose of inhaled hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP), the oropharyngeal deposition of which is very low, can eliminate the infection without deterioration of asthma.. A total of 10 stable asthmatic patients with esophageal candidiasis, induced by inhaled FP-dp treatment (400 or 800 microg/ day), were enrolled in this study. A second upper GI endoscopy was performed, more than 1 month but less than 3 months after switching to an equal dose of inhaled HFA-BDP with a tube spacer device, Duopacer. The patients' medications were not changed during the study.. Esophageal candidiasis was eliminated in 9 of the 10 patients. The degree of candidiasis reduced in another patient. The forced expiratory volume in 1 sec (FEV1.0) did not worsen during the study.. Switching from FP-dp to HFA-BDP with Duopacer is useful in preventing esophageal candidiasis.

Topics: Administration, Inhalation; Aged; Aged, 80 and over; Androstadienes; Anti-Asthmatic Agents; Beclomethasone; Candidiasis; Esophageal Diseases; Esophagoscopy; Female; Fluticasone; Humans; Male; Metered Dose Inhalers; Middle Aged; Powders

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

The efficacy of inhaled beclomethasone dipropionate has been examined in 44 steroid-dependent asthmatics observed for 9 months to 2 years. A 3-month double-blind trial found that subjects treated with beclomethasone had a significant diminution in symptoms, were able to reduce their use of medication, and had improved maximum expiratory flow rates. Approximately one half were able to discontinue the use of oral prednisone within 9 months after starting beclomethasone, and a further one third reduced their dose by at least 50%. No characteristics could be defined to predict responsiveness to beclomethasone. The effectiveness of beclomethasone was sustained for as long as 2 years and was not associated with any abnormal urine, blood, or serum values or chest X-ray findings. Candidiasis of the palate appeared in approximately one third of the subjects and was usually transient. The chronic use of beclomethasone did not result in endocrine suppression.

Topics: Administration, Oral; Aerosols; Anti-Bacterial Agents; Asthma; Beclomethasone; Candidiasis; Clinical Trials as Topic; Forced Expiratory Volume; Humans; Placebos; Prednisone; Substance-Related Disorders; Vital Capacity

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aerosols; Aged; Aspergillosis; Asthma; Beclomethasone; Candidiasis; Child; Child, Preschool; Chronic Disease; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Pregnancy; Seasons; Substance-Related Disorders; Time Factors

Topics: Administration, Oral; Administration, Topical; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candidiasis; Chronic Disease; Clinical Trials as Topic; Drug Therapy, Combination; Glucocorticoids; Humans; Methylprednisolone; Mouth Diseases; Mouth Mucosa; Nystatin; Pharyngeal Diseases; Placebos; Prednisone; Propionates

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

In general, steroid is mainly used as anti-inflammatory action in case of allergic diseases. As one of the side effects of inhalation steroid, a report is given below regarding buccal capsule/esophageal candidiasis. The patient came to the hospital with the chief complaint regarding passage dysphagia in the time of deglutition; pharyngitis and esophageal candidiasis were found by endoscopy of upper gastrointestinal tract.The interview after the endoscopy revealed that the patient, a 69-year-old female was diagnosed as chronic perennial allergic rhinitis a few years ago, and had been inhaling rhinenchysis Beclometasone dipropionate (BDP) before sleep every day for the past two years because using this collunarium seemed to mitigate the nasal obstruction and mucus during sleep. The patient did not report this fact before the endocsopy because she did not associate it with her subjective symptom. In this case, it was assumed that nebulized rhinenchysis BDP was accidentally swallowed to the pharynx and esophagus during sleep. As a treatment, rhinenchysis BDP was canceled and instead Azunol mouth washing (gargling/nasal douche) was used. No antifungal agent was used. In two weeks, the patient reported some improvement, and this was confirmed by reexamination of the upper gastrointestinal tract using endoscope in one month and a half. Pharyngitis was improved, and in the digital endoscopic assessment of esophageal candidiasis complicating inhaled steroid therapy the esophageal candidiasis became Grade I (mild grade). As for the later progress, the patient did not report any subjective symptoms such as nasal obstruction and dysphagia. In addition, the inflammation caused by candidiasis and found in the early examination was improved. The patient in this case was under treatment for thrombosis in the vein of lower extremity, but no complications such as diabetes mellitus or immune deficiency syndrome were observed.. Esophageal candidiasis by chronic administration of inhalation of steroid before sleep for asthmatic patients has been reported. However, there has not been a report of esophageal candidiasis by chronic administration of rhinenchysis steroid before sleep for patients with allergic rhinitis. Similarly, in the case of the use of steroid in the form of collunarium before sleep, steroid stayed in the esophagus via the transendothelial nasal cavity, and that seemed to cause, in the long run, to develop esophageal candidiasis.. One of the implications of the above case is that collunarium can go down, even when it is nebulized in the nasal cavity, to the esophagus via the nasal cavity to buccal capsule. This suggests the necessity for preventative measures in the case of chronic administration of steroid as follows. A. Blowing of the nose just after the use of collunarium B. Daily rinsing (gargling and nasal douche).

Topics: Administration, Inhalation; Aged; Beclomethasone; Candidiasis; Esophageal Diseases; Female; Glucocorticoids; Humans; Nasal Obstruction; Rhinitis, Allergic, Perennial; Sleep; Time

Physicians (n = 84) across the country prescribed candid-B cream (clotrimazole 1% + beclomethasone dipropionate 0.025%) on 822 patients suffering from candidiasis with inflammatory diseases to evaluate the efficacy and safety of the combination. The results showed reduction in severity was more than 80% for all symptoms/signs except scaling and lichenification where the reduction was 76.05% and 66.03% respectively. Only one patient complained of adverse reaction. So in the treatment of coexisting candidiasis and inflammatory dermatoses the combination of clotrimazole 1% + beclomethasone 0.025% (candid-B cream) was found to be highly effective.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Antifungal Agents; Beclomethasone; Candidiasis; Clotrimazole; Dermatitis; Drug Combinations; Female; Glucocorticoids; Humans; India; Male; Middle Aged

A 49-year-old woman was admitted to hospital because of productive cough and dyspnea. She had been well two months before admission, when she developed an attack of asthma. Chest roentgenogram taken on admission revealed numerous shadows of inhomogeneous density in both lungs. Laboratory findings showed leukocytosis with eosinophilia (25%), high IgE level in serum and positive RAST score to Candida albicans. A diagnosis of allergic bronchopulmonary candidiasis was made by these laboratory data and clinical course. The patient was treated successfully by oral administration of methylprednisolone and inhalation of amphotericin B, but she had a relapse of the disease on cessation of steroid medication. Inhalation of beclomethasone dipropionate and procaterol hydrochloride was commenced. Thereafter, pulmonary infiltration and clinical symptoms improved after three weeks.

Topics: Administration, Inhalation; Beclomethasone; Candidiasis; Female; Humans; Lung Diseases, Fungal; Middle Aged; Respiratory Hypersensitivity

Topics: Administration, Intranasal; Beclomethasone; Candidiasis; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Middle Aged; Nose Diseases; Time Factors

Extrapulmonary effects of alternate-day prednisone and inhaled beclomethasone dipropionate therapy were examined in 24 and 32 children with asthma, respectively. Early morning serum cortisol values were significantly lower among patients receiving alternate-day prednisone than among patients receiving inhaled beclomethasone dipropionate and control subjects at 24 hours but not at 48 hours after an alternate-day prednisone dose. Urinary-free cortisol output during the second 24 hours of the alternate-day prednisone regimen were similar to values among patients receiving inhaled beclomethasone and were significantly lower than among control subjects for both groups. Mean heights among patients before being placed on maintenance corticosteroids were at the thirty-fifth percentile and were similar for both regimens. This was significantly lower than initial measurements for control subjects who, on average, were near the fiftieth percentile for both children with asthma not requiring maintenance corticosteroids and normal healthy Iowa children. Mean heights for both corticosteroid-treated groups remained at the thirty-fifth percentile after more than a 2-year average duration of follow-up. Heights of children with chronic asthma not requiring maintenance corticosteroids were initially significantly higher (fifty-first percentile) than the patients who subsequently required maintenance corticosteroids and increased significantly to the sixty-first percentile during a mean 2.7-year follow-up. Heights of healthy Iowa children remained near the fiftieth percentile during a mean 7-year follow-up. Disproportionate weight gain, although it was not consistently present, was significantly more likely with the alternate-day prednisone. Other extrapulmonary effects of the corticosteroid regimens appeared not to be of clinical importance during the time period of the study.

Topics: Administration, Inhalation; Adolescent; Asthma; Beclomethasone; Blood Cell Count; Body Height; Body Weight; Candidiasis; Cataract; Child; Female; Growth; Hematocrit; Hemoglobins; Humans; Hydrocortisone; Immunoglobulins; Male; Prednisone

Two hundred and twenty nine children aged 6 to 15 years attending the asthma clinic at the Royal Hospital for Sick Children, Edinburgh, had throat swabs taken to determine the incidence of candida colonisation of the oropharynx. One hundred children (group A), who were not receiving steroids, were compared with 91 children (group B) receiving less than 500 micrograms of inhaled beclomethasone a day and 38 children (group C) receiving 500 micrograms or more of inhaled beclomethasone a day. Sore throat and hoarse voice were not related to the presence of candida or to treatment with inhaled steroids. The incidence of candida was greater in the groups given treatment with steroids but did not increase at a higher dosage, nor was it related to the type of inhaler used. There was only one case of clinical thrush in all the children studied.

Topics: Adolescent; Beclomethasone; Candidiasis; Child; Dose-Response Relationship, Drug; Humans; Respiratory Therapy

Nine of 14 asthmatic patients who presented with persistent dysphonia while taking inhaled corticosteroids had a bilateral adductor vocal cord deformity with bowing of the cords on phonation. This causes the dysphonia and usually occurs without candidiasis. It was seen with beclomethasone dipropionate (in both pressurised aerosol and dry powder preparations), betamethasone valerate, and budesonide. It was related to the dose and potency of inhaled steroid and may represent a local steroid myopathy. It was reversed when the inhaled steroid was stopped, although resolution sometimes took weeks. Laryngeal candidiasis may have contributed to the vocal cord abnormality in two of these nine patients. Of the five patients without vocal cord deformity, laryngeal candidiasis was the sole cause of dysphonia in three. In the remaining two dysphonia was thought to be psychogenic. The vocal cord deformity may exist subclinically. Of nine patients who started to take aerosol steroid and who were examined monthly for one year, three developed vocal cord deformity but only one had persistent dysphonia. Vocal abuse did not appear to contribute to dysphonia.

Topics: Adult; Aged; Beclomethasone; Betamethasone Valerate; Budesonide; Candidiasis; Female; Glucocorticoids; Humans; Laryngeal Diseases; Larynx; Male; Middle Aged; Pharynx; Pregnenediones; Vocal Cords; Voice Disorders

Topics: Adolescent; Adult; Beclomethasone; Candidiasis; Dermatitis, Occupational; Female; Humans; Male; Middle Aged; Occupational Diseases; Pharyngeal Diseases; Tinea Versicolor

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

The effect of inhaled beclomethasone dipropionate (dose, 400 mug daily) was investigated in 31 prednisone-dependent asthmatics. In a double-blind noncrossover study of 25 patients dependent on a daily prednisone dose of 17.5 mg or less, the dose of ingested prednisone was significantly diminished through the use of beclomethasone as compared with placebo (P < 0.001). In a subsequent single-blind study of the 12 patients who had received placebo, a similar decrease in prednisone dose was possible when these patients received beclomethasone. In all 25 patients the effect of beclomethasone was maintained for 2 years; 9 came to require less beclomethasone and 1 required more. In an additional single-blind study of six patients with severe asthma, dependent on prednisone in a dose of 20 to 25 mg/d, the response to beclomethasone was more variable and less significant (P < 0.01). However, at 2 years there was no significant benefit (P > 0.05) and there were two treatment failures.In patients in whom reduction of dose or discontinuation of prednisone was possible plasma cortisol values before and after corticotropin administration increased significantly (P < 0.001). Prednisone reduction was associated with the appearance of mild musculoskeletal steroid-withdrawal symptoms of short duration in 15 patients, and recurrence of symptoms of rhinitis in 15 patients. Side effects of beclomethasone included episodes of hoarseness in 6 and easily treated oropharyngeal Candida albicans infection in 14.

Topics: Administration, Oral; Adolescent; Adult; Aged; Asthma; Beclomethasone; Candidiasis; Female; Humans; Male; Middle Aged; Prednisone; Respiratory Therapy; Substance-Related Disorders

Topics: Adult; Antifungal Agents; Asthma; Beclomethasone; Candida; Candidiasis; Humans; Mouth; Pharynx

Topics: Administration, Topical; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candida albicans; Candidiasis; Glucocorticoids; Humans; Methylprednisolone

Topics: Administration, Topical; Adolescent; Aerosols; Anti-Inflammatory Agents; Asthma; Beclomethasone; Candidiasis; Child; Female; Glucocorticoids; Humans; Male; Methylprednisolone