Inhaled corticosteroids are the mainstay of anti-inflammatory treatment in patients with chronic asthma, and most patients' symptoms are controlled by low or moderate doses of these agents. However, there are some patients with chronic severe asthma whose symptoms are inadequately controlled by high doses of inhaled corticosteroids and maximal bronchodilator therapy. Such patients require increasingly frequent courses of oral corticosteroids, often culminating in their long term use.

Until recently in the UK, budesonide (Pulmicort Respules, Astra Pharmaceuticals) was the only corticosteroid available for nebulisation. Fluticasone propionate (Flixotide Nebules, Glaxo Wellcome) was launched in late 1998, and is being actively marketed. The 1995 British Thoracic Society asthma guidelines state, however, that there are ". . . no published controlled trials of the effectiveness of nebulised budesonide in adults".¹ This review aims to address whether these guidelines hold true, or whether new evidence has emerged which should lead us to review this policy.

The evidence for . . . [Full text of this article]