Inhaled corticosteroids (Efficacy)

Asthma is a complex genetic syndrome that affects about 300 million people worldwide. The response to treatment is also genetically complex and is characterized by a high intra-individual repeatability, where up to 40% of patients with asthma might not have a response to therapy. Inhaled glucocorticoids are the most prescribed medicines for controlling asthma. Endogenous glucocorticoids are inherited and vary both at the beginning of treatment and in response to changes in the environment. On one hand, studies of families having distinct asthma conditions have shown familial segregation as well as heritability in glucocorticoid response. Given the heritability within the therapeutic class of glucocorticoids as well as the high degrees of variability among patients and within the repeatability in the inhaled glucocorticoid response for asthma treatment, it is probable that this response has a genetic base.

The hypothesis of some studies by the genetic association is to identify new variants linked to the response of for asthma. This hypothesis has been put to the test with the use of the algorithm for inhaled glucocorticoids the diagnosis of asthma in the families of subjects randomly assigned to inhaled glucocorticoids in the Childhood Asthma Management Program (CAMP). By means of this detection, SNPs have been identified that offer a greater potential for an association that in addition is reproducible for the response to inhaled glucocorticoids, measured as a change in the forced expiratory volume in 1 second (FEV1). After the selection, the association of the SNPs of four additional populations taken from independent clinical trials with asthma patients was tested.

Budesonide as a corticoid inhaler

Budesonide is a corticosteroid that is administered intranasally or by inhaling to control the symptoms of stuffiness and runny nose due to allergies. It has a strong glucocorticoid activity while its mineralocorticoid activity is weak. Budesonide also has a topic anti inflammatory effect with a low systemic activity. Oral budesonide has proven to be the same as prednisone for the treatment of Crohn disease but with a lesser number of adverse reactions.

Secondary effects

Budesonide may produce secondary effects such as:

  • Local: oropharyngeal candidiasis (thrush) and dysphonia (the most frequent); they are significantly reduced by the use of holding chambers.
  • Systemic (with high sustained doses): psychomotor hyperactivity, sleep alterations, anxiety, depression, aggressiveness, Cushing syndrome, adrenal suppression, growth delay in children and adolescents, cataracts or glaucoma
  • Nose irritation or burning
  • Bleeding or sores in the nose
  • Lightheadedness
  • Upset stomach
  • Cough
  • Hoarseness
  • Dry mouth
  • Rash
  • Sore throat
  • Bad taste in mouth
  • Change in mucus color
  • Muscle cramps

In addition, the following symptoms should be reported immediately:

  • Breathing difficulties or swelling of the face
  • Irregular menstrual periods
  • Severe acne
  • White spots in the throat, mouth or nose

On rare occasions, behavioral changes (mostly affecting children)

BRAND NAMES

  • Rhinocort®
  • Pulmicort®
  • Turbuhaler®


Genes analyzed

7p21.3 TBX21

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