Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000;2001(2):CD002160.
doi: 10.1002/14651858.CD002160.

Inhaled vs oral steroids for adults with chronic asthma

B Mash  1 , A Bheekie, P W Jones
Affiliations

Inhaled vs oral steroids for adults with chronic asthma

B Mash et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Objectives: To determine therapeutically equivalent doses of inhaled versus oral steroids for adults with chronic asthma.

Search strategy: The Cochrane Airways Group trials register was searched using the terms: (drug delivery systems OR ((nebuli* OR inhal* OR MDI) AND oral*)) AND ( steroid* OR corticosteroid* OR glucocorticoid* OR beclomethasone OR betamethasone OR fluticasone OR cortisone OR dexamethasone OR hydrocortisone OR prednisolone OR prednisone OR triamcinolone).

Selection criteria: Randomised controlled trials were selected of at least 4 weeks duration and included patients over the age of 15 years with chronic asthma. Trials compared inhaled steroids and oral prednisolone or prednisone; where the maximum dose for inhaled steroids was 2000 mcg/day and prednisolone 60 mg (on alternate days).

Data collection and analysis: Two independent reviewers screened 1285 titles and abstracts from the electronic search, bibliography searches and other contacts. Of these, 10 trials met previously defined inclusion criteria. Two reviewers independently extracted study characteristics, and outcome measures.

Main results: All trials were small and no data could be pooled. Carry-over effects were present in at least one cross-over trial. Data from six trials produced the same pattern, in which prednisolone 7.5-12 mg/day appeared to be as effective as inhaled steroid 300-2000 mcg/day. In two trials, inhaled steroid 300-400 mcg/day was more effective than prednisolone 5 mg/day. All doses of inhaled steroid appeared to be more effective than alternate day doses of prednisolone up to 60 mg on alternate days. Side-effect data were reported too variably to permit comparisons. A 30% incidence was reported in one study in patients receiving prednisolone 5 mg/day, none were reported in patients on inhaled steroids.

Reviewer's conclusions: A daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Side-effects may be present on low doses, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed.

PubMed Disclaimer

Conflict of interest statement

None.

Similar articles

See all similar articles

Cited by

  • Inhaled Corticosteroids.
    Barnes PJ. Barnes PJ. Pharmaceuticals (Basel). 2010 Mar 8;3(3):514-540. doi: 10.3390/ph3030514. Pharmaceuticals (Basel). 2010. PMID: 27713266 Free PMC article. Review.
  • [Guideline-adherent treatment for asthma].
    Sieren M, Buhl R, Taube C. Sieren M, et al. Internist (Berl). 2008 Nov;49(11):1311-2, 1314, 1316 passim. doi: 10.1007/s00108-008-2134-8. Internist (Berl). 2008. PMID: 18841343 German.

References

References to studies included in this review

Bosman 1994 {published data only}
    1. Bosman HG, Uffelen R. Different effects of inhaled beclomethasone dipropionate and oral prednisone on bronchial hyperresponsiveness in asthma [Abstract]. European Respiratory Journal 1990;3(Suppl):101s.
    1. Bosman HG, Uffelen R, Tamminga JJ, Paanakker LR. Comparison of inhaled beclomethasone dipropionate 1000mcg twice daily and oral prednisone 10mg once daily in asthmatic patients. Thorax 1994;49:37‐40. - PMC - PubMed
BTTA 1975 {published data only}
    1. British Thoracic and Tuberculosis Association. Inhaled corticosteroids compared with oral prednisone in patients starting long‐term corticosteroid therapy for asthma. Lancet 1975;2(7933):469‐73. - PubMed
Eriksson 1975 {published data only}
    1. Eriksson NE, Lindgren S, Lindholm N. A double‐blind comparison of beclomethasone dipropionate aerosol and prednisolone in asthmatic patients. Postgraduate Medical Journal 1975;51(Suppl 4):70‐1. - PubMed
Jenkins 1988 {published data only}
    1. Jenkins C, Woolcock AJ. Effect of prednisone and beclomethasone dipropionate on airway responsiveness in asthma: a comparative study. Thorax 1988;43:378‐84. - PMC - PubMed
Lahdensuo 1974 {published data only}
    1. Lahdensuo A, Alanko K, Poppius H, Harkonen M. A comparative study of the efficacy of inhaled beclomethasone and systemic prednisolone in bronchial asthma. Scandinavian Journal of Respiratory Diseases 1974;55:309‐19. - PubMed
Lal 1972 {published data only}
    1. Lal S, Harris DM, Bhalla KK, Singhal SN, Butler AG. Comparison of beclomethasone dipropionate aerosol and prednisolone in reversible airways obstruction. BMJ 1972;3:314‐7. - PMC - PubMed
Namsirikul 1989 {published data only}
    1. Namsirikul P, Chaisupamongkollarp S, Chantadisai N, Bamberg P. Comparison of inhaled budesonide with oral prednisolone at two dose‐levels commonly used for the treatment of moderate asthma. European Respiratory Journal 1989;2:317‐24. - PubMed
Rosenhall 1982 {published data only}
    1. Rosenhall L, Lundqvist g, Alderoth E, Glennow C. Comparison between inhaled and oral corticosteroids in patients with chronic asthma. European Respiratory Journal 1982;122:154‐62. - PubMed
Toogood 1987 {published data only}
    1. Toogood JH. Efficiency of inhaled versus oral steroid treatment of chronic asthma. New England and Regional Allergy Proceedings. 1987; Vol. 8, issue 2:98‐103. - PubMed
Toogood 1989 {published data only}
    1. Toogood JH, Baskerville J, Jennings B, Lefcoe NM, Johansson SA. Bioequivalent doses of budesonide and prednisone in moderate and severe asthma. Journal of Allergy & Clinical Immunology 1989;84:688‐700. - PubMed

References to studies excluded from this review

CAMP 1999 {published data only}
    1. CAMP. Design, rationale and methods. Controlled Clinical Trials 1999;20:91‐120. - PubMed
Cooper 1977 {published data only}
    1. Cooper EJ, Grant IW. Beclomethasone dipropionate aerosol in treatment of chronic asthma. Quarterly Journal of Medicine 1977;46(183):295‐308. - PubMed
Fitzgerald 2000 {published data only}
    1. Fitzgerald, et al. A RCT of high dose, inhaled budesonide versus oral prednisone in patients discharged from the emergency department following an acute asthma exacerbation. Canadian Respiratory Journal 2000;7(1):61‐7. - PubMed
Higenbottam 2000 {published data only}
    1. Higenbottam, et al. Comparison of nebulised budesonide and prednisolone in severe asthma exacerbation in adults. Biodrugs 2000;14(4):247‐54.
Meijer 1999 {published data only}
    1. Meijer RJ, Kerstjens HA, Arends LR, Kauffman HF, Koeter GH, Postma DS. Effects of inhaled fluticasone and oral prenisolone on clinical and inflammatory parameters in patients with asthma. Thorax 1999;54(10):894‐9. [MEDLINE: ] - PMC - PubMed
Prakash 1976 {published data only}
    1. Prakash C, Chopra JS, Chugh VK. Double blind cross over trial of beclomethasone dipropionate aerosol and oral prednisolone in bronchial asthma. Journal of the Association of Physicians of India 1976;24(5):301‐4. - PubMed
Takahashi 1994 {published data only}
    1. Takahashi K, et al. Usefulness of inhaled steroids in steroid‐dependent intractable asthma ‐ equivalent dose of oral steroid to inhaled steroid. Japanese Journal of Allergology 1994;43(9):1163‐71. - PubMed
Varshavskii 2003 {published data only}
    1. Varshavskii BI, Trubnikov GV, Galaktipmpva LP, Koreniak NA, Koledeznaia IL, Oberemok AN. Oxidant‐antioxidant status of patients with bronchial asthma during inhalation and systemic glucocorticoid therapy [Oksidantno‐antioksidantnyi status bol'nykh bronkhial'noi astmoi pri ingaliatsionnoi u sustenbii gkuyjijirtujiudbii terapii]. Terapevticheskii Arkhiv 2003;75(3):21‐4. - PubMed
Wempe 1992 {published data only}
    1. Wempe JB, Postma DS, Breederveld N, Alting‐Hebing D, Mark T, Koeter G. Separate and combined effects of corticosteroids and bronchodilators on airflow obstruction and airway hyper‐responsiveness in asthma. Journal of Allergy & Clinical Immunology 1992;89(3):679‐87. - PubMed
Wilmsmeyer 1990 {published data only}
    1. Wilmsmeyer W, Ukena D, Wagner TO, Sybrecht GW. First‐time treatment with steroids in bronchial asthma: comparison of the effects of inhaled beclomethasone and of oral prednisone on airway function, bronchial reactivity and hypothalamic‐pituitary‐adrenal axis. European Respiratory Journal 1990;3:786‐91. - PubMed

Additional references

BTS 1993
    1. British Thoracic Society. Guidelines for the management of asthma. BMJ 1993;306:776‐82. - PMC - PubMed
Carveth 1999
    1. Carveth HJ, Kanner RE. Optimizing deposition of aerosolized drug in the lung: a review. Medscape Respiratory Care 1999; Vol. 3, issue 1:Available at: http://www.medscape.com/viewarticle/408738 [Accessed 6/12/2007].
Ebbutt 1998
    1. Ebbutt AF, Frith L. Practical issues in equivalence trials. Statistics in medicine 1998;17:1691‐701. - PubMed
Jones 1996
    1. Jones B, Jarvis P, Lewis JA, Ebbutt AF. Trials to assess equivalence: the importance of rigorous methods. BMJ 1996;313:36‐9. - PMC - PubMed
Mash 1997
    1. Mash B. An audit of asthma care in Khayelitsha Community Health Centre. South African Family Practice Journal 1997;18(3):3‐6. - PubMed
Reid 1986
    1. Reid DM, Nicoll JJ, Smith MA, Higgins B, Tothill P, Nuki G. Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica. BMJ 1986;293:1463‐6. - PMC - PubMed
SAG 1992
    1. SAG. Guidelines for the management of asthma ‐ South Africa. South African Medical Journal 1992;81:319‐22. - PubMed
Sharek 1999
    1. Sharek PJ, Bergman DA, Ducharme F. Beclomethasone for asthma in children: effects on linear growth. Cochrane Database of Systematic Reviews 1999, Issue 3. [Art. No.: CD001282. DOI: 10.1002/14651858.CD001282.] - PMC - PubMed
Smyllie 1968
    1. Smyllie HC, Connolly CK. Incidence of serious complications of corticosteroid therapy in respiratory disease. Thorax 1968;23:571‐81. - PMC - PubMed
Toogood 1982
    1. Toogood JH, Baskerville JC, Jennings B, Lefcoe NM, Johansson SA. Influence of dosing frequency and schedule on the response of chronic asthmatics to the aerosol steroid, budesonide. Journal of Allergy & Clinical Immunology 1982;70(4):288‐98. - PubMed
Toogood 1984
    1. Toogood JH, Baskerville J, Barbara J, Lefcoe NM, Johansson S. Use of spacers to facilitate inhaled corticosteroid treatment of asthma. American Review of Respiratory Disease 1984;129:723‐9. - PubMed
Walters 1999
    1. Walters EH, Walters JAE. Many reports of RCTs give insufficient data for Cochrane reviewers. BMJ 1999;319(7204):257. - PMC - PubMed

Publication types