Dose-response relationship of inhaled budesonide in adult asthma: A meta-analysis

Abstract

The aim of this study was to examine the dose-response relationship of inhaled budesonide in adolescents and adults with asthma. A meta-analysis was carried out on placebo-controlled, randomised clinical trials, presenting data on at least one outcome measure of asthma and using at least two doses of budesonide, delivered by turbuhaler or metered-dose inhaler+spacer twice daily. A total of six studies of 1,435 adolescents and adults, with mild to moderately severe asthma, met the inclusion criteria for the meta-analysis. A negative exponential model indicated that 80% of the benefit at 1,600 μg·day-1 was achieved at doses of ∼200-400 μg·day-1 and 90% by 300-600 μ g·day-1. Meta-regression with a quadratic term in dose showed that the maximum effect was obtained with doses of ∼1,000 μ g·day-1. In conclusion, the available published data indicate that, in adolescents and adults with mild to moderate asthma, most of the therapeutic benefit of budesonide delivered by turbuhaler or metered-dose inhaler+spacer is achieved with a dose of ∼400 μ g·day-1 and the maximum effect is achieved at ∼ 1,000 μg·day-1. This conclusion is qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids and that the subjects included in this meta-analysis had predominantly mild to moderate asthma. © ERS Journals Ltd 2004.