Two patients with brittle asthma whose bronchial obstruction was less variable during treatment with HFA-beclomethasone (HFA-BDP) solution aerosol than with other previous treatments are presented here. In order to evaluate whether this improvement was related to the smaller particle size of the new formulation (MMAD 1.1 mu vs 4 mu with the CFC-formulation) both patients participated in a prospective case study sequence.
Method: During a 4 week run-in both patients inhaled 200 micrograms of HFA-BDP (Ventolair) BID from the Autohaler followed by 4 weeks of treatment with 500 micrograms CFC-BDP (Aerobec) BID from the Autohaler in study phase 1 and 4 weeks of treatment with 200 mcg HFA-BDP (Ventolair) BID from the Autohaler in study phase 2. During the entire study period other concomitant medications remained unchanged. The dose of CFC-BDP was chosen to be 2.5 times higher than the HFA-BDP dose to get approximately comparable amounts of intrabronchial deposition. During the study Peak-Flow and concomitant medications were recorded daily.
Results: Both patients showed significantly higher Peak-flow values during treatment with Ventolair (HFA-BDP) than during treatment with AeroBec (CFC-BDP). P-values were p < 0.0001 and p < 0.005 for patient 1 and 2 respectively.
Conclusion: At a comparable intrabronchial dose these two cases of brittle asthma showed significant improvements in control of bronchial obstruction with a BDP-formulation of smaller particle size. This is an indicator that smaller airways in the periphery of the lung participate in the inflammatory process leading to bronchial obstruction and that deposition of inhaled steroids in this region could have therapeutic advantages.