Asthma

The recommended dose of ciclesonide is 160 micrograms once daily, which leads to asthma control in the majority of patients. In patients with severe asthma and while reducing or discontinuing oral corticosteroids, a higher dose of up to 640 mcg/day (given as 320 mcg twice daily) may be used. Patients should be given a dose of inhaled ciclesonide which is appropriate to the severity of their disease. Symptoms start to improve with ciclesonide within 24 hours of treatment. Once control is achieved, the dose of ciclesonide should be individualised and titrated to the minimum dose needed to maintain good asthma control. Dose reduction to 80 micrograms once daily may be an effective maintenance dose for some patients.

Ciclesonide should preferably be administered in the evening although morning dosing of ciclesonide has also been shown to be effective. The final decision on evening or morning dosing should be left to the discretion of the physician.

Patients with severe asthma are at risk of acute attacks and should have regular assessments of their asthma control including pulmonary function tests. Increasing use of short-acting bronchodilators to relieve asthma symptoms indicates deterioration of asthma control. If patients find that short-acting relief bronchodilator treatment becomes less effective, or they need more inhalations than usual, medical attention must be sought. In this situation, patients should be reassessed and consideration given to the need for increased anti-inflammatory treatment therapy (e.g. a higher dose of ciclesonide for a short period or a course of oral corticosteroids). Severe asthma exacerbations should be managed the usual way.