Year: 1999
Type: article
Abstract: We read with interest the study of Campbell et al1 in the September 1998 issue of this journal and agree with the result that an initial loading dose of 400 μg budesonide twice daily may have an adavantage over 400 μg nocte. In general, local application of steroids is a first line strategy in asthma. However, we feel that the design does not consider current knowledge of chronotherapy with steroids.2, 3 Single morning doses may be much more effective than single evening doses and, more importantly, even if the overall risk of local steroids is small, they produce fewer side-effects when given in the morning. In particular, the suppression of the HHA-axis is clearly reduced. From the chronobiological point of view, 400 μg budesonide given in the morning and 400 μg budesonide given in the evening are not the same, so the difference between the study groups may be explained by the morning administration, not just by the dose itself. An interesting question would be: do twice-daily morning/evening doses produce the same results as a once-daily morning dose or twice-daily morning/afternoon doses? For practical reasons, one should strive for a single morning dose, because such a regimen is easier for the patient, particularly elderly asthmatics who often have to take five or more drugs. Anything that simplifies dosage schedules is an advantage. We encourage the authors to investigate such therapeutic dosage schedules and would be interested to hear about the results.
Institutions: University Hospital Regensburg, Klinikum Fulda
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4367476135