Effect of inhaled ciclesonide on airway responsiveness to inhaled AMP, the composition of induced sputum and exhaled nitric oxide in patients with mild asthma

To assess the efficacy of ciclesonide, a novel corticosteroid pro-drug, we compared its effect on lung function, airway responsiveness to inhaled AMP, the composition of induced sputum, and the level of exhaled nitric oxide (NO),vith the effect of budesonide in patients with asthma. Fifteen non-smoking steroid-naive patients (mean FEV1, 94%pred) inhaled either 400 mug ciclesonide or 400 mug budesonide as a single morning dose for two weeks each separated by a greater than or equal to3 week wash-out period. The study was performed in a double-observer, randomized, cross-over design. FEV1 increased significantly during treatment with budesonide (3.38 vs. 3.641; P=0,003), but not after ciclesonide (3.60 vs. 3.69 I). PC20FEV1 of AMP increased (P<0,001, each) after both budesonide (4.59 vs. 32.48 mg/ml, 2.8 doubling doses) and ciclesonide (3.92 vs. 20.00 mg/ml, 2.4 doubling doses). The percentage of sputum eosinophils was significantly reduced after ciclesonide (7.9 vs. 3.4%; P=0.01), but not budesonide (6.0 vs. 4.3%). After both budesonide and ciclesonide, a significant (P<0.001) reduction in the level of exhaled NO occurred. In none of the parameters studied, the changes differed significantly between treatment with budesonide or ciclesonide. These data suggest that ciclesonide is equi-effective to budesonide with regard to its potency to reduce the airway responsiveness to inhaled AMP as well as airway inflammation in patients with mild asthma. (C) 2001 Academic Press.