Beclomethasone in childhood asthma.
نویسنده
چکیده
It has not been possible so far to produce a systemic corticosteroid with anti-inflammatory effect on local tissues and without glucocorticoid action. However, esterification of the potent antiinflammatory steroid betamethasone with valeric acid in the 17 carbon position produced betamethasone-17-valerate (Betnovate*), a steroid with marked topical anti-inflammatory activity. Beclomethasone dipropionate, a chlorinated analogue of betamethasone esterified with propionic acid, has greater topical anti-inflammatory activity and has been marketed for dermatological use as Propaderm. A pressurized aerosol containing beclomethasone (Becotidet) is now undergoing clinical trials, of which two are reported on pages 665 and 671 of this issue, in the hope that the margin of difference between the high local topical activity and the systemic glucocorticoid effects will be greater than can be achieved with other steroids whether given orally, systemically, or by inhalation. That there is a differential effect of this kind has not yet been definitely established. There has been no experimental animal evidence so far, despite high and prolonged dosage, to suggest any toxic action on the lung (D. Poynter, personal communication, 1973). The drug is cleared from the lung within an hour, whereas it persists in the skin much longer (D. M. Harris, personal communication, 1973). A large proportion of the inhaled dose is deposited in the mouth and pharynx and is swallowed (Blackwell et al., 1970). Absorption from the alimentary tract is rapid, the drug appearing in the plasma 5 minutes after swallowing a microfine suspension. These authors also showed that a micronized suspension after inhalation is almost completely absorbed via the gut and perhaps also the lung, and subsequently is slowly excreted in the urine and bile. Evidence is accumulating that daily inhalations in excess of 1 mg cause sufficient systemic absorption to depress hypothalamic-pituitary-adrenal function in normals (Harris et al., 1973) and asthmatics (Choo-Kang et al., 1972). The drug is inhaled from a metered aerosol delivering 50 pLg per dose, and the usual dose is 300 to 600 ,ug per day. Reports
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Godfrey, S., and Konig, P. (1973). Archives of Disease in Childhood, 48, 665. Beclomethasone aerosol in childhood asthma. Twenty children have been treated with the steroid aerosol beclomethasone, half of them in an open trial and the other half in a controlled cross-over trial. Children were assessed by means of clinical examination, diary records, and twice-daily peak flow rate measurements m...
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عنوان ژورنال:
- Archives of disease in childhood
دوره 48 9 شماره
صفحات -
تاریخ انتشار 1973