Systemic side effects of beclomethasone dipropionate aerosols (Becotide, Aldecine, Sanasthmyl) in otherwise non steroid treated asthmatic patients
Beclomethasone dipropionate (0.4 mg daily) or its propellent carrier alone used as placebo (oleic acid and fluorens) was inhaled by a group of sixteen otherwise non steroid treated asthmatic patients with stable perennial asthma. The mean FEV1 was 1780 ml and increased by more than 20% (mean 47%) after orciprenaline aerosol. The double blind controlled study lasted three weeks. Weekly control assessment at 8 a. m. included arterial blood gas sampling for plasma cortisol level, white blood cell count and blood gas analysis, followed by spirometry and clinical evaluation. Prior to control assessment, the last beclomethasone or placebo aerosol was taken at midnight. No significant improvement of lung function was observed in the beclomethasone group or in the placebo group. Systemic side effects were seen in both groups. The group inhaling the propellent carrier alone showed a significant increase in the basal plasma cortisol level and the absolute blood eosonophil count at the end of the second and the third week of the study. In contrast, in the beclomethasone group a significant decrease of the plasma cortisol level and the absolute blood eosinophil count was observed at the end of the second and third week. During the beclomethasone inhalation the absolute blood neutrophil count increased significantly, whereas during the inhalation of the propellent carrier alone the absolute blood monocyte count rose significantly. It thus appears that the propellent carrier of beclomethasone dipropionate has plasma cortisol mobilizing properties and stimulates cellular immune defenses through an uncertain mechanism. The systemic activity of the propellent carrier of beclomethasone produces an effect apparently opposite to the systemic side effects of beclomethasone aerosol.