Inhaled fluticasone versus (HFA) beclomethasone dipropionate for chronic asthma in adults and children

Inhaler devices used to deliver steroids in asthma broadly fall into three categories. Those which use a propellant to dispense the steroid in to the airway via the mouth when the canister is pressed manually (pressurised metered dose inhalers - pMDIs), those which use a propellant to deliver a dose of the steroid triggered by the user breathing in (breath actuated MDIs), and those which deliver the drug as dry powder (DPI). The pMDIs have traditionally used a chlorofluorocarbon (CFC) propellant, but the phasing out of CFC-inhalers has had major implications for the manufacturing of inhaled drugs. A new non-CFC propellant (hydrofluoroalkane-134a (HFA)) has been introduced, and it is used to propel beclomethasone (BDP). Previously fluticasone (FP) was thought to be at least as effective as CFC-BDP when given at half the dose. The review of studies found that there was a limited amount of evidence to show that the newer extra-fine form of BDP was similar to FP at the same dose. More research should be done in children and in people with more severe asthma to help answer the question of what the relative effects of these two steroids are. Some people may not be particularly good at using certain inhaler types and the findings of the review may only really apply to people who are competent in using metered-dose inhalers (MDIs). Studies should consider introducing spacers where people find these easier to use.