Inhaled budesonide may be less potent than beclomethasone in primary care

Asthma treatment guidelines internationally regard inhaled budesonide and beclomethasone as equipotent on the basis of randomised trials which have usually shown no difference. Randomised clinical trials to compare potency are, however, inherently difficult to design. Rather than assessing efficacy in response to fixed doses of corticosteroids, Pethica et al on p 986 analysed the daily prescribed doses for 5930 patients in primary care in New Zealand. In this setting doses are usually adjusted according to the clinical response. Mean beclomethasone doses were significantly lower than those for budesonide, and the difference could not be attributed to severity of asthma. The authors conclude that inhaled budesonide is less potent than beclomethasone in primary care.