[An evaluation of the acceptance of budesonide turbuhaler by older Japanese patients with bronchial asthma when changed from fluticasone propionate (FP) or beclomethasone dipropionate (BDP)].
Although the clinical reputation of the inhaled steroid budesonide(R) (BUD) has become well established in Europe and the USA, we found that in clinical practice many older Japanese patients were resistant to changing to this form of inhaled steroid from fluticasone propionate (FP) or beclomethasone dipropionate (BDP). This study was accordingly designed to evaluate the acceptability and clinical efficacy of budesonide in older Japanese patients with bronchial asthma.


METHODS
Forty-five Japanese asthma patients aged over 65 (22 using FP and 23 using BDP) were changed to BUD inhalation from their existing inhaled steroid. After two weeks, patients were questioned as to their acceptance of BUD, their inhalation technique was checked, and the duration of inhalation required to dispense the drug and peak expiratory flow (PEF) was measured. The rate of pharyngeal candidiasis was also assessed, both before and after changing to BUD.


RESULTS
Most of the patients in both groups considered BUD inhalation to be easy and could quickly learn to use the Turbuhaler. However, as no sensation of drug inhalation was generally experienced, over 70% of patients felt anxious about whether they had successfully inhaled the medication. Furthermore, there were various misunderstandings in correct inhaler technique. Although there were no significant differences in PEF or in the rate of pharyngeal candidiasis before and after changing to BUD administration, side effects occurred in about 40% of both groups. In patients aged 65-74, 50.0% of patients who had previously been taking FP and 38.9% of those who had previously been taking BDP intended to continue BUD inhalation, while in patients over 75, only 8.3% of former users of FP and 20.0% of former users of BDP intended to continue using BUD.


CONCLUSIONS
In older patients, factors influencing satisfaction with inhaled medication include not only ease of use and time needed to become accustomed to a new delivery method, but also the important issue of satisfaction with the sensation of drug inhalation.
Ohbayashi
Hiroyuki
H
Internal Medicine, JA Gifu Showa Hospital. ohbayasi@nn.iij4u.or.jp
Yamase
Hirohiko
H
D000287:Administration, Topical; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D017060:Patient Satisfaction
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D019819:Budesonide; D000068298:Fluticasone; D001507:Beclomethasone