Ciclesonide versus other inhaled steroids for chronic asthma in children and adults

Inhaled corticosteroids, such as budesonide, beclomethasone or fluticasone, which have been available for many years, have proven to be an important therapy for controlling the inflammation caused by asthma. They are given usually twice daily, and are recommended therapy in international guidelines for most asthmatics. However, the currently available inhaled corticosteroids can be associated with significant side-effects, including local effects in the upper airways such as hoarseness and oral candida (thrush infection). Ciclesonide is a new steroid which is reported to make less of the active steroid available until the drug reaches the lung on inhalation, which could reduce the likelihood of throat symptoms. This findings of this review of 21 trials (7243 participants) do not allow certainty about the relative efficacy of ciclesonide compared to older inhaled corticosteroids, especially at higher doses. The results of the review to date do not indicate whether ciclesonide provides a significantly more useful safety profile that other inhaled corticosteroids at similar equivalent doses. However, the finding of lower oral candidiasis in patients treated with ciclesonide compared to fluticasone may be important for those patients who experience oral thrush with their current ICS. In addition, further studies in children are required to obtain data on the side-effect profile of ciclesonide in this population.