Why Alvesco?

Help your mild-to-moderate asthma patients breathe easier with Alvesco (ciclesonide). It’s the inhalation aerosol that has small particles of asthma medicine designed to go deep into airways where it may help reduce asthma inflammation.1,2

Alvesco Inhalation Aerosol targets both large and small airways of the lungs.3

Lung Graphic

Asthmatic inflammation can occur throughout the tracheobronchial tree. With a small particle size of 1-2 µm, Alvesco is able to reach areas of chronic inflammation within the lung.3 In fact, most of the Alvesco that was deposited in the lungs was found in the small airways and alveoli.2

  • Aerosol particle size is a key factor in both the extent of lung deposition and the regional distribution within the lung.4
  • ICS particle sizes <2 µm in diameter are more likely to reach the small airways of the lungs. Here they can have a targeted effect without as many local adverse effects in the throat and oral cavities as inhalers with larger particle sizes.3

*Particle size does not necessarily correlate with clinical efficacy

Due to its small particle size, 52% of the delivered Alvesco Inhalation Aerosol dose was deposited in the lungs.2,†,§

52%

Deposition in Lungs

Representative 2D lung deposition pattern of 99m Tc ciclesonide HFA in an asthmatic patient.

Study Design: Single-dose, open-label, nonrandomized study performed in 12 patients with mild asthma. Patients received a single dose of 99mtechnetium (Tc)-ciclesonide HFA 320 mcg ex-actuator (400 mcg ex-valve). The primary study variable was the total and regional distribution of ciclesonide in the lungs, oropharynx, and exhaled air.2

Small Particle Size graphic

†Based on 2-dimensional (2D) scintigraphy
§Scintigraphy is not a valid surrogate for clinical effect

The importance of treating all airways in the lungs.

Treatment with anti-inflammatory drugs can usually reverse some of the airway inflammation and hyperresponsiveness.5

Since inflammation, remodeling, and obstruction can occur in airways of all sizes, it is important for the anti-inflammatory treatment to be able to reach all the airways.6

treating all airways graphic

The total surface area of the small distal airways is much greater than that of the large central airways, so inflammation along these distal surfaces may make a significant contribution to the symptoms of asthma.5,6

Acute and chronic inflammation can increase bronchial hyperresponsiveness and enhance susceptibility to bronchospasm.7 Allergens such as pollen, cat dander, and mold spores have particle sizes small enough to reach the smallest airways, where they can trigger asthma symptoms if the airways are inflamed.8

Delivering anti-inflammatory medication to distal airways.5

  • Anti-inflammatory treatment needs to be directed to both the large and small airways in order to reach all the areas that might have inflammation.4
  • One study showed that Iarge inhaled corticosteroid (ICS) particles (2.6–4.5 µm diameter) had <20% deposition in the lung, whereas small ICS particles (<2 µm) had >50% lung deposition.8
  • Small ICS particles (<2 µm) are more likely to reach the small airways (defined as <2 µm in diameter) where they can exert their anti-inflammatory effect.6,8

Steroid receptors.

  • Steroid receptors are present in nearly all cells of the respiratory tract, and the smaller airways actually have even more steroid receptors than the large airways.8
  • It has been shown that ICSs have a topical anti-inflammatory effect at the location where they are deposited in the lung tissue – not through systemic absorption.8
  • Increasing the precision of ICS delivery and deposition has the potential to enhance the anti-inflammatory effects.8

Asthma control.

Inflammation and remodeling in small airways have been shown to contribute to clinical asthma symptoms. Specifically, greater dysfunction of the small airways—but not the large airways—has been associated with worse asthma control.6 It is harder to keep asthma under control if the medicine cannot reach the small airways.

Multiple clinical studies, including rigorous dose-response studies and comparative clinical trials against CFC inhalers have shown that when small-particle ICS drug delivery enables more deposition throughout the lung, there is an improvement in clinical efficacy and comparable asthma control at lower doses.8 Treatment directed toward reducing inflammation can reduce airway hyper-responsiveness and improve asthma control.7

Alvesco in 3D action.

Alvesco in 3D action

ALVESCO is indicated for the maintenance treatment of asthma as prophylactic therapy in adult and adolescent patients 12 years of age and older.

Important Limitations of Use:

ALVESCO is NOT indicated for the relief of acute bronchospasm

ALVESCO is NOT indicated for children under 12 years of age

References:

  1. Alvesco® Inhalation Aerosol Prescribing Information. Zug, Switzerland: Covis Pharma; April 2019.
  2. Newman S, Salmon A, Nave R, Drollman A. High lung deposition of 99mTc-labeled ciclesonide administered via HFA-MDI to patients with asthma. Respiratory Medicine. 2006;100:375-384.
  3. Rohatagi S, Derendorf H, Zech K. Risk-Benefit Value of Inhaled Corticosteroids: A Pharmacokinetic/Pharmacodynamic Perspective. Chest. 2003;123:430S-431S.
  4. Martin RJ. Therapeutic significance of distal airway inflammation in asthma. J Allergy Clin Immunol. 2002;109 (Suppl 2):S447-S460.
  5. Hamid Q. Pathogenesis of Small Airways in Asthma. Respiration. 2012;84:4–11.
  6. van der Wiel E, ten Hacken NHT, Postma DS, van den Berge M. Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review. J Allergy Clin Immunol. 2013;131:646-657.4.
  7. National Asthma Education and Prevention Program (NAEPP). Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma–Full Report 2007. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, Lung, and Blood Institute; August 2007. https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/full-report. Accessed October 14, 2017
  8. Leach C, Colice GL, Luskin A. Particle size of inhaled corticosteroids: Does it matter? J Allergy Clin Immunol. 2009;124:S88-S93.