Inhaled Steroid Drugs

Background

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common conditions in the U.S. About 20 million Americans have asthma. Some five million are children. Each year, about two million people visit a hospital emergency department because of an asthma attack, and some 4,500 die. As many as 24 million Americans have COPD, the fourth leading cause of death in the U.S.

Doctors use several different types of medicines to treat both these conditions. One is a class of drugs called inhaled steroids. There are six medicines in this class. To help you and your doctor evaluate and choose among them, Consumer Reports has analyzed the steroid inhalers based on their effectiveness, safety, dosing convenience, and cost. This brief is a summary of an 18-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an Inhaled Steroid?

Inhaled steroids reduce and help prevent inflammation and mucus build-up in your airways. They help prevent asthma attacks and keep you breathing easier if you have either asthma or COPD. Not everyone needs an inhaled steroid drug. Sometimes, prevention (especially quitting smoking) and lifestyle adjustments work well. But, if you or your child have persistent asthma (see below), your doctor is very likely to prescribe an inhaled steroid. If you have mild COPD, your doctor may discourage regular use of an inhaled steroid. If you have moderate to severe COPD, however, your doctor may advise trying one for several months to see if it helps.

Gradations of Asthma

Mild Intermittent

•Your asthma comes and goes, with symptoms, either during the day or at night, occurring twice a week or less.

Mild Persistent

•You have symptoms more than twice a week, but not every day. Asthma attacks affect your activity.

Moderate Persistent

•You have symptoms every day and attacks often affect your activity.

Severe Persistent

•You have symptoms throughout the day, most days. Activity is limited.

Source: National Heart, Lung, and Blood Institute

Stages of COPD

At Risk

•Normal breathing test, but mild signs include chronic cough and sputum production.

Mild COPD

•Mild airflow limitation on breathing test. Cough and sputum production.

Moderate COPD

•Worsening breathing difficulty when working hard, walking fast, or during brisk activities.

Severe COPD

•Severe airflow limitation on breathing test. Shortness of breath even after very little activity.

Source: National Heart, Lung, and Blood Institute

Our Recommendations

Inhaled steroids are effective and safe. Their use in the treatment of asthma is well established. Their effectiveness against COPD is less clear cut. Fewer studies have evaluated the drugs in treating COPD.

The six drugs do not differ in their effectiveness treating asthma. However, because of each drug’s unique properties, some of the inhaled steroids are prescribed only to children of certain ages. Your doctor will know about these restrictions.

The inhaled steroid medicines differ in their potency, convenience of use, the inhaler device in which they are packaged, and their cost.

Taking all factors into account, we have chosen the following inhaled steroids as Consumer Reports Best Buy Drugs for treating adult and childhood asthma and adult COPD:

•Beclomethasone (QVAR) 80 mcg—for adults and children aged 5 and over with asthma

•Budesonide (Pulmicort Turbuhaler) 200 mcg—for adults with asthma who may prefer a dry powder inhaler and for children with asthma aged 6 and over

•Fluticasone (Flovent HFA) 110 mcg—for children with asthma aged 12 and over

•Fluticasone (Flovent HFA) 220 mcg—for children aged 12 and over and adults with asthma, and for adults with moderate to severe COPD

•Mometasone (Asmanex Twisthaler) 220 mcg—for adults with asthma

All of these medicines are well priced at the low and medium number of puffs needed per day. In addition, at these doses, low- and medium-level use requires fewer puffs per day. That assures better compliance and control of your symptoms.

If you or your child has severe asthma, the cost of inhaled steroids is greater—over $200 a month. That makes talking with your doctor about the most affordable inhaled steroid even more important.

The information in this brief was last updated in April 2006.

Cost Comparison

Generic Name and Strength

Brand Name

Use1

Puffs Per Day2

Average Monthly Cost3

Beclomethasone 40 mcg

QVAR

Low

4

$87

Medium

9

$196

High4

16

$349

Beclomethasone 80 mcg inhaler

QVAR

Low

2

$51

Medium

4 to 5

$115

High4

8

$204

Budesonide 200 mcg

Pulmicort Turbuhaler

Low

2

$60

Medium

4 to 5

$136

High

8

$241

Flunisolide 250 mcg

AeroBid

Low

3

$86

Medium

6

$172

High4

11

$316

Flunisolide 250 mcg

AeroBid-M (menthol flavored)

Low

3

$82

Medium

6

$164

High4

11

$302

Fluticasone 44 mcg

Flovent HFA

Low

4

$92

Medium

10 to 11

$241

High

19

$436

Fluticasone 110 mcg

Flovent HFA

Low

1 to 2

$45

Medium

4

$119

High

8

$239

Fluticasone 220 mcg

Flovent HFA

Low

1

$46

Medium

2

$92

High

4

$184

Mometasone 220 mcg inhaler (30 puffs per inhaler)5

Asmanex Twisthaler

Low

1

$122

Medium

2

$244

High

3

$366

Mometasone 220 mcg (60 puffs per inhaler)5

Asmanex Twisthaler

Low

1

$61

Medium

2

$121

High

3

$182

Mometasone 220 mcg (120 puffs per inhaler)5

Asmanex Twisthaler

Low

1

$41

Medium

2

$82

High

3

$124

Triamcinolone 100 mcg

Azmacort

Low

7

$100

Medium

15

$214

High4

25

$357

Note: This cost table applies to adults only. Our full report contains a separate cost table for children since the choice of inhaled steroids for children with asthma depends on different factors. To view or obtain that table, please download (for free) our full 18-page report at CRBestBuyDrugs.org.

1. The range of low to high use is from the National Asthma Education and Prevention Program (NAEPP) Expert Panel. We use the mid-point of low and medium dosing ranges and an approximation of a reasonable dose in the high dosing range to further classify the number of puffs per day and average monthly cost.

2. The number of puffs per day reflects the mid-point or a reasonable estimate based on the NAEPP dosing categories.

3. Prices reflect nationwide retail average for December 2005, rounded to the nearest dollar. This information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

4. This dosing exceeds the manufacturer’s highest recommend dose, but is consistent with the NAEPP Expert Panel Report’s classification of a high dose.

5. This drug comes in an inhaler programmed to deliver a specified number of puffs.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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