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Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
To prevent adrenal crisis, chronic asthma patients require additional steroid therapy for asthma control during the stress of labor if they have received oral steroid therapy for more than 2 weeks within the previous year. The usual regimen is hydrocortisone, 100 mg IM or IV every six to eight hours for 24 hours. Corticosteroids should be given in cases of severe or mild asthma with wheezing that is unresponsive to bronchodilators. Initially, prednisone, 30–60 mg daily is given to prevent status asthmaticus. Beclomethasone dipropionate is effective and safe when prolonged steroid use is necessary.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
After inhalation, an amount of the drug will reach the systemic circulation and can result in systemic effects. The amount of drug reaching the systemic circulation is determined by the fraction deposited in the airways (pulmonary fraction) and in the mouth (oral fraction). The oral fraction will be swallowed and absorbed. How much of this fraction becomes available for the systemic circulation depends on the first pass metabolism in the liver. The more recently developed inhaled corticosteroids (e.g. fluticasone proprionate, mometasone furoate and budesonide) have a low oral bioavailability. 50 to 70% of the swallowed fraction of beclomethasone dipropionate, triamcinolone and flunisolide is metabolised. The pulmonary fraction is likely to be more or less completely absorbed in active form to the systemic circulation. The systemic concentration will be reduced by continuous recirculation and inactivation of the drug by the liver.
Beclomethasone Dipropionate
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
A 51-year-old woman, using an inhaler containing beclomethasone dipropionate for asthma, noted scales and fissures on the lips and erythema and pigmentation on the perioral area and jaw. Patch tests were positive to the inhaler, a cream with beclomethasone dipropionate and the corticosteroid itself tested at 20% water. The cheilitis and dermatitis cleared after using another inhalant (3).
A drift on liposomes to proliposomes: recent advances and promising approaches
Published in Journal of Liposome Research, 2022
Neha Dhiman, Jayrajsinh Sarvaiya, Poorti Mohindroo
Khan et al. developed Beclometasone dipropionate (BDP) proliposomes using a novel ‘slurry method’ approach by taking a higher amount of lipid to carrier ratio (1:5–1:15 w/w). Beclometasone dipropionate (BDP) is categorized as inhaled steroid, used in form of aerosols for the treatment of allergic asthma. Carbohydrate carrier was dispersed in an alcoholic solution of phospholipid followed by evaporation of the solvent under negative pressure, to yield lipid-coated carbohydrate granules, referred to as ‘proliposomes.’ According to the research team, the proliposomes generated from the slurry method produced small-sized liposomes upon hydration with better EE compared to other conventional methods (thin-film and feed line method). As the slurry method is a very new approach hence further work needs to explore for deciding its suitability for hydrophilic, hydrophobic, and amphipathic drug compounds (Brown et al.1972, Khan et al.2015).
Detecting asthma exacerbations using daily home monitoring and machine learning
Published in Journal of Asthma, 2021
Olivier Zhang, Leandro L. Minku, Sherif Gonem
We utilized a large dataset of daily PEF and symptom scores which were recorded by participants in the SAKURA study (NCT00839800), an international multicentre randomized controlled trial comparing budesonide/formoterol as maintenance and reliever therapy versus budesonide/formoterol maintenance plus terbutaline as reliever, in patients age ≥ 16 years with persistent asthma (10). Eligibility criteria included a documented history of persistent asthma for at least 6 months, reversible airway obstruction (increase in forced expiratory volume in one second [FEV1] of at least 12% relative to baseline with administration of a bronchodilator), use of maintenance inhaled corticosteroids (ICS) for at least 3 months before study entry, and having at least one asthma exacerbation in the 12 months prior to study entry. Current or previous smokers with a smoking history of ≥ 10 pack years were excluded. The study population had a mean age of 46 years with 68% being female. The mean beclometasone dipropionate equivalent ICS dose at study entry was 1023 µg/day, and 62% of patients were using long-acting β2 agonists at study entry. The mean baseline FEV1 was 70% predicted, with mean reversibility following administration of a bronchodilator of 23%.
New perspectives on the role of muscarinic antagonists in asthma therapy
Published in Expert Review of Respiratory Medicine, 2020
Maria Gabriella Matera, Carmela Belardo, Michele Rinaldi, Barbara Rinaldi, Mario Cazzola
The two Phase III trials (Triple in Asthma With Uncontrolled Patients on Medium Strength of ICS + LABA [TRIMARAN] and Triple in Asthma High Strength Versus ICS/LABA HS and Tiotropium [TRIGGER]) showed that adding glycopyrronium 10 μg two inhalations twice-daily to medium-to-high dose of ICS (beclometasone dipropionate 100 μg and 200 μg, respectively) plus a LABA (formoterol fumarate 6 μg) two inhalations twice-daily for 52 weeks in adults with uncontrolled asthma improved lung function and was associated with a reduction of severe exacerbations compared with ICS/LABA [56]. In TRIGGER study, no statistically significant difference was observed between the beclometasone dipropionate/formoterol fumarate/glycopyrronium 200/6 μg/10 μg two inhalations twice-daily group and beclometasone dipropionate/formoterol fumarate 200/6 μg two inhalations twice-daily plus tiotropium Respimat 2.5 μg two inhalations once-daily group after 26 weeks in the pre-dose FEV1 (−45 mL) and the rate of moderate and severe exacerbations (1.07).