Safety and efficacy of beclomethasone dipropionate delivered by breath-actuated or metered-dose inhaler for persistent asthma

Background: Breath-actuated inhalers (BAI) have been developed to simplify the delivery of inhaled medication. Objective: To evaluate the safety and efficacy of beclomethasone dipropionate hydrofluoroalkane BAI and metered-dose inhaler (MDI) versus placebo in patients who previously used a mid-to high-dose inhaled corticosteroid or inhaled corticosteroid/long-acting beta agonist for persistent asthma. Methods: This phase III study included five treatment groups: placebo, and four beclomethasone dipropionate groups (BAI 320 mu g/day, BAI 640 mu g/day, MDI 320 mu g/day, and MDI 640 mu g/day). Efficacy over 12 weeks was assessed by spirometry, peak flow measurements, and other clinical end points. Safety was assessed by adverse events. Results: Baseline-adjusted trough morning forced expiratory volume in 1 second area under the effect curve from time 0 to 12 weeks (primary end point) was increased in the BAI 320 and BAI 640 mu g/day groups and the MDI 640 mu g/day group versus placebo (not significant). Clinically important improvements were noted in morning and evening peak expiratory flow and decreased rescue medications. More patients who received placebo than patients in active treatment groups withdrew due to meeting the stopping criteria for worsening asthma. Patients in the active treatment groups experienced a greater decrease in asthma symptoms than patients in the placebo group. Quality of life and Asthma Control Test scores improved in the active treatment groups compared with the placebo group (p < 0.0074). The most common adverse events (>5% in any group) were oral candidiasis and upper respiratory tract infection. Conclusion: Clinical benefits for patients who used BAI 320 and 640 mu g/day and MDI 640 mu g/day were demonstrated. The safety profiles of BAI 320 and 640 mu g/day were comparable with that of the MDI. These benefits and the continued need for better symptom control among patients with asthma support the continued development of this controller medication.