Comparison of the efficacy of different budesonide inhalation devices in newly diagnosed mild bronchial asthma

ObjectiveTo compare the effects of regular inhaled corticosteroids (ICS) using different inhalation devices combined with on-demand short-acting β2-receptor agonist (SABA) on symptoms, respiratory impedance, lung function and airway inflammation in newly diagnosed patients with mild bronchial asthma. MethodsA total of 53 patients with newly diagnosed mild bronchial asthma were prospectively enrolled. Using SAS software (version 9.4), the participants were randomly assigned in a 1:1 ratio to a pressurized metered-dose inhaler (pMDI) group of 26 patients and a dry powder inhaler (DPI) group of 27 patients. Both groups received budesonide 200 μg per dose twice daily for 4 weeks. Asthma control test (ACT) scores, lung function, impulse oscillometry (IOS) parameters, fractional exhaled nitric oxide (FeNO) and blood eosinophil (EOS) levels were assessed before and after treatment. ResultsThere were no significant differences in baseline data, lung function, IOS, FeNO or EOS between the 2 groups (P>0.05). IOS parameters were correlated with lung function indicators. After 4 weeks of treatment, ACT scores increased, while FeNO and EOS decreased, and peak expiratory flow (PEF) increased compared with baseline in both groups (all P<0.05). The improvement in forced expiratory flow at 25% of forced vital capacity (FEF25%) in the pMDI group was significantly greater than that in the DPI group (P<0.05). Stratified analysis showed that in patients with small airway dysfunction (SAD), FeNO≥25 ppb, or EOS≥150 cells/μL, the pMDI group exhibited more significant FEF25% improvement after treatment (P<0.05). The proportion of patients achieving an ACT score of 25 in the pMDI group was significantly higher than that in the DPI group. ConclusionsAfter 4 weeks of budesonide treatment in patients with newly diagnosed mild asthma, the change in FEF25% and the proportion with well-controlled symptoms were higher in the pMDI group than in the DPI group, while both are comparable in terms of airway inflammation improvement and safety. Baseline FEV1 reversibility and abnormalities in small airway function may predict a better therapeutic effect of pMDI.