As Needed Beclomethasone/Salbutamol Combination in Single Inhaler for Mild Persistent Asthma

Condition(s) targeted: Asthma

Intervention: beclomethasone/salbutamol combination (Drug); beclomethasone (Drug); salbutamol (Drug)

Phase: Phase 3

Status: Completed

Sponsored by: Chiesi Farmaceutici S.p.A.

Official(s) and/or principal investigator(s):
Leonardo M Fabbri, MD, Principal Investigator, Affiliation: Clinica di Malattie dell’Apparato Respiratorio, Dipartimento di Oncologia, Ematologia e Pneumologia, Università di Modena e Reggio Emilia, Italy

The aim of this study is to reveal that inhaled corticosteroid therapy combined with a short-acting beta2- agonist given on a symptom driven basis is as effective as traditional asthma therapy.

Thus, three advantages will be achieved:

1. better compliance with treatment since patients will most likely have to administer the treatment less frequently,

2. maximum pharmacological effect with the least amount of drug and

3. less economic burden on health care providers.

Official title: Multinational, Double Blind, Randomised, Parallel Group Study on the Therapeutic Efficacy and Safety of Beclomethasone Dipropionate 250 mg Combined With Salbutamol 100 mg in the Treatment of Patients With Mild Persistent Asthma.

Study design: Treatment, Randomized, Double-Blind, Active Control, Parallel Assignment, Efficacy Study

Primary outcome: The primary outcome for comparison across treatment groups was the mean value of morning PEF measured during the last 2 weeks of treatment (weeks 23-24)

Secondary outcome:

Number of exacerbations

Time to first severe exacerbation

Improvement of asthma symptoms (symptom scores)

Need for short acting b2 agonists

Variation of respiratory parameters (FEV1, PEF, FVC, FEV1/FVC, FEF25-75) immediately before and 30 min after a test with a short-acting b2 agonist

evening PEF

Diurnal variability of PEF

Nocturnal asthma (nocturnal awakening because of asthma)

Nights and days without asthma symptoms (score 0)

Detailed description: Asthma is widely recognised as a chronic inflammatory disorder of the airways. The 1997 American National Heart Lung and Blood Institute (NHLBI) Guidelines states that a firm scientific basis exists to indicate that asthma results from complex interactions among inflammatory cells, mediators and the cells and tissues resident in the airways.

Despite the existence of effective therapy people still die from asthma. It is pertinent to state that the clinical effect of a drug is not only dependent on the specific action of the drug, but also on the patient’s way of using it. Therefore, compliance is an important factor especially for chronic disorders such as asthma. Indeed, non compliance with asthma therapy is a serious problem. It has been reported that drug side effects, lifestyle, social and economic factors, method of drug delivery and dosing are factors that contribute to poor compliance. The consequences of poor compliance lead to increased morbidity due to increased symptoms and asthma exacerbation.

The NHLBI Guidelines recommend daily treatment for patients with mild persistent asthma with inhaled glucocorticoids (200-500mcg/die) and short-acting bronchodilators as needed but no more than 3-4 times a day.

Comparisons: beclomethasone dipropionate 250 mg combined with salbutamol 100 mg “as needed”, vs salbutamol 100 mg alone “as needed”, vs beclomethasone 250 mg twice a day plus salbutamol 100 mg “as needed” and vs beclomethasone dipropionate 250 mg combined with salbutamol 100 mg twice a day plus salbutamol 100 mg “as needed”, in the treatment of patients with mild persistent asthma.

Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Clinical diagnosis of mild persistent asthma as defined by NHLBI/WHO 97; for at least

6 months;

- FEV1 ³ 75% of predicted normal value;

- Positive response to the reversibility test to b2 agonist, defined as an increase >

12% in the FEV1 measured 30 minutes following 2 puffs (2x100mg) of inhaled Salbutamol spray, or positive methacholine challenge (PC20<8mg/ml or PD20<1 mg) within the previous 6 months;

- Stable asthma. Asthma is defined stable if none of the following occurred during the

last 14 days of the run-in period: diurnal variation of more than 20% in PEF on 2 consecutive days; use of four or more inhalations of b2 agonist per day on two consecutive days; need the use of oral corticosteroids;

Exclusion Criteria:

- COPD as defined by the ERS – Consensus Statement;

- Patients with more than 10 packs/year of cigarettes history and current smokers;

- History of near fatal asthma and/or admission in intensive care unit because of

asthma;

- One severe exacerbation during the run-in period;

- Three or more courses of oral corticosteroids or hospitalisation for asthma during the

previous 1 year;

- Patients treated with more than 500 mcg/day of beclomethasone or equivalent for more

than 6 months in the previous last year;

Pulmologisches Zentrum Der Stadt Wien, Wien, Austria

Ambulance for pediatrics and Pneumology, Wien, Austria

Dipartimento di scienze mediche oncologiche e radiologiche - sez. malattie apparato respiratorio, Modena, Italy

DIMI - Dip. Medicina Interna - Univ. di Genova - clinica di malattie apparato respiratorio e allergologico, Genova, Italy

Clinica Pneumologica padiglione Rasori - Univ. di Parma, Parma, Italy

Nuove Cliniche Arcispedale S.Anna, Ferrara, Italy

Univ. di Padova - Dipartimento di medicina ambientale e sanità pubblica, Padova, Italy

Dip. di Pneumologia - Osp. Tommaselli, Catania, Italy

Clinica di Malattie dell'Apparato Respiratorio dell'Univ. di Pavia - Policlinico S. Matteo, Pavia, Italy

Istituto di Fisiopatologia Respiratoria CNR - Ospedale Cervello, Palermo, Italy

Reparto Fisiologia Respiratoria - dip. Cardiotoracico - Ospedale Cisanello, Pisa, Italy

Clinic of Pneumology and Allergology, Lòdz, Poland

Clinic of Tubercolosis and Lung Diseases, Lòdz, Poland

Outpatient Clinic of Internal Diseases and Allergology, Bialystok, Poland

Clinic of Pneumology and Allergology of Medical Academy, Warszawa, Poland

Clinic of Pneumology - Institute of Internal Medicine of Medical Academy, Lódz, Poland

Clinic of Pneumology and Allergology A.M., Warszawa, Poland

Institute of Occupational Medicine - Clinic of Occupational Disesase, Lódz, Poland

Specialist Group Medex, Bielsko Biala, Poland

Clinic of Infection Diseases and Allergology - Central Clinical Hospital of Military Medical Academy, Warszawa, Poland

Clinic of Internal Diseases Atopia Al., Krakow, Poland

Pulmonologic Clinic - Poludnie os. Krakowiakòw, Krakow, Poland

Hospital Vall d'Hebron de Barcelona, Barcelona 08035, Spain

H.General de Vic, Servicio de Neumologia, Barcelona 08500, Spain

Hospital de Matarò, Mataro 08304, Spain

Starting date: August 2002
Ending date: September 2004
Last updated: September 29, 2006