BACKGROUND: Inhaled corticosteroids (ICSs) are widely used in asthma control. Ciclesonide (CIC) is an ICS with on-site lung activation for potent anti-inflammatory activity. AIMS: This study aimed to compare the clinical benefit of CIC with budesonide (BUD) in step-down therapy. METHODS: A total of 150 patients with mild-to-moderate asthma well controlled by a combination of ICS and long-acting β2-agonist were randomised to receive either CIC 320 μg (n = 75) once daily or 2 inhalations of BUD 200 μg (n = 75) twice daily for 12 weeks. The forced expiratory volume in 1 s (FEV1), maximum mid-expiratory flow (MMEF) and asthma control test (ACT) scores were measured. Ranked stratification of patients and physicians was assessed. RESULTS: Drug adherence was significantly higher in the CIC group than in the BUD group (76.0% vs. 58.7%, P = 0.03). The FEV1 and MMEF remained stable throughout the 12-week CIC treatment. In the BUD group, FEV1 significantly decreased at weeks 4 and 12. MMEF had a higher value in the CIC group than in the BUD group. Both patients and physicians ranked CIC over BUD. CONCLUSIONS: CIC is more effective and has better drug adherence than BUD as step-down treatment when asthma is well controlled by combination therapy.
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