Qvar vs. Becotide vs. Flixotide

What are the differences between these three preventers?

[KateMoss]

Qvar and Becotide are the same steroid drug - beclomethasone but in different inhalers & made by different people. (I don't think Becotide is still made as an MDI by Glaxo?)

Flixotide (drugname fluticasone) is a newer one and supposed to be more effective - comes in MDIs and dry powder inhalers.

[Hidden]

Hi,

In the UK there are five main inhaled steroids used as preventers in asthma: beclomethasone (AeroBec, AsmaBec, Beclozone, Becodiscs, Cenil, Qvar, generic beclomethasone), budesonide (Novolizer, Pulmicort, generic budesonide and compound preparation Symbicort), circlesonide (Alvesco), fluticasone (Flixotide and compound preparation Seretide), and mometasone (Asmanex). There are various delivery devices available for all the preparations and budesonide and fluticasone are also available as nebuliser solutions.

Most of the traditional and large scale studies into preventative inhaled steroid treatment in asthma have been done using beclomethasone CFC-containing MDI, which is no longer available. These results have been generalised to the use of the other inhaled steroids, with the help of comparative studies.

Studies have shown that there is no clear and consistent difference between the different inhaled steroids, although many doctors have their own personal ideas and preferences and some patients may respond better to one steroid than another for individual reasons that are not clearly understood. There are some dose variations - for example, fluticasone and mometasone are usually considered to be twice as strong as the other inhaled steroids in most preparations - but in practice all this means is that patients take half the dose.

Mometasone and ciclesonide are relatively new inhaled steroids and therefore tend not to be used as much; comparison studies have not really shown that they are any better than the old reliables. There is a limited amount of evidence to suggest that ciclesonide may have lower systemic (body-wide) absorption and therefore fewer systemic side effects (only really a problem in children and in adults on extremely high doses) and possibly fewer oropharangeal side effects such as oral thrush and hoarseness. As mometasone and ciclesonide are new, their safety and efficacy (effectiveness) have not been extensively studied or completely established.

The British Thoracic Society Asthma Guidelines (which aim to be highly evidence based) do not particularly recommend any one inhaled steroid above the others, due to the lack of evidence to support one being consistently better than any of the others. The guidelines do suggest caution with mometasone and circlesonide due to the newness and comparative lack of safety data of these drugs.

There is considerable ancedotal evidence that some patients respond better to one drug than another; people may also have individual preferences as to which delivery devices they prefer or can tolerate. For example, many of the drug powder inhalers contain lactose, which some people are allergic to, and other people may be allergic to the propellant in MDIs ('puffers'). This obviously will be a strong influence in the inhaler chosen for any one patient. Often if a patient has not responded well to one inhaled steroid, a physician will try another to see if there is any variation in response.

Hope this rather long-winded answer sheds some light!

Take care

Em H

[Hidden]

No, Kate, Becotide is not available in MDI form from Glaxo in this country - the only version of beclomethasone in the BNF now from Allen and Hanbury's (who are now a subsidiary of GlaxoSmithKline) is Becodiscs. I don't know if other formulations may be available in other countries.

[Hidden]

Qvar also has smaller particle size compared to becotide and clenil, again in practice this usually means halving the dose (even though it is effectively the same drug).

[Hidden]

Oooops, yes, I forgot about that - thanks, Cathbear!

[KateMoss]

Thanks Em, I have since browsed the BNF site to see where things were up to with beclomethasone as I haven't used the stuff for years!