title: Real-life comparison of beclometasone dipropionate as an extrafine- or larger-particle formulation for asthma.
abstract: BACKGROUND
  Beclometasone dipropionate is an inhaled corticosteroid (ICS) available in both extrafine and larger-particle hydrofluoroalkane formulations. Extrafine beclometasone has greater small airway distribution and inhalation technique tolerance than larger-particle beclometasone; therefore, its use may be associated with improved asthma outcomes at population levels. The study objective was to compare real-life effectiveness of extrafine and larger-particle beclometasone.
  
  
  METHODS
  Retrospective matched cohort study including primary care patients with asthma (ages 12-60 and non-smokers 61-80 years) prescribed extrafine or larger-particle beclometasone by metered-dose inhaler. We studied patients receiving their first ICS (initiation population, n = 11,289) or switched from another ICS without dose change (switch population, n = 19,065). The extrafine and larger-particle beclometasone cohorts were matched in each population for demographic and database measures of asthma control during a baseline year; and endpoints assessed during 1 outcome year were adjusted for residual confounding factors.
  
  
  RESULTS
  The odds of no loss of asthma control (no asthma-related hospital attendance, consultation for lower respiratory tract infection, or oral corticosteroids) were significantly higher in the extrafine beclometasone cohorts of both initiation population (adjusted odds ratio [aOR] 1.12; 95% CI 1.02-1.23) and switch population (aOR 1.10; 95% CI 1.01-1.19). The odds of better adherence to ICS therapy were also significantly higher in both extrafine beclometasone cohorts (initiation population, aOR 1.64; 95% CI 1.52-1.75 and switch population, aOR 1.35; 95% CI 1.27-1.43).
  
  
  CONCLUSIONS
  These findings are consistent with the hypothesis that delivery of beclometasone in extrafine particle size produces real-life asthma treatment benefits. Clinical trials no. NCT01400217.
authors: Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. david@rirl.org
authors: David
authors: D
authors: Price
authors: Mike
authors: M
authors: Thomas
authors: John
authors: J
authors: Haughney
authors: Richard A
authors: RA
authors: Lewis
authors: Anne
authors: A
authors: Burden
authors: Julie
authors: J
authors: von Ziegenweidt
authors: Alison
authors: A
authors: Chisholm
authors: Elizabeth V
authors: EV
authors: Hillyer
authors: Christopher J
authors: CJ
authors: Corrigan
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D002626:Chemistry, Pharmaceutical; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000737:chemistry / Q000627:therapeutic use; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D010316:Particle Size; D011320:Primary Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D001507:Beclomethasone