In a population of 400 patients with chronic asthma treated with beclomethasone dipropionate aerosol (BDA) 371 continued this treatment for a period of at least one year. Of these 371 patients 55 had not previously received any form of corticosteroid therapy, but the remaining 316 had been on regular systemic treatment with either corticosteroids or corticotrophin for at least six months.A standardized grading of the response to BDA was used to evaluate the contribution of this form of treatment to the control of each patient's asthma. On that basis BDA therapy was either completely effective (Grade 1 response) or fairly effective (Grade 2 response) in 63 per cent of cases, and totally ineffective in only 10 per cent. BDA was significantly more effective as‘primary’than as‘secondary’treatment, presumably because it was used as‘primary’treatment in less severe cases.Although a slightly better response to BDA therapy was recorded in males, in patients between the ages of 20 and 40, and in those who had been on regular treatment with systemic corticosteroids for less than five years, none of these differences was statistically significant. Factors which had no influence on the response to treatment included age at onset of asthma, history of other allergic disorders, atopic status (as determined by cutaneous prick tests) and skin sensitivity toAspergillus fumigatus. A signifcantly better response to BDA was, however, recorded in those patients who had been receiving a maintenance dose of prednisolone in excess of 10 mg per day than in those on a smaller maintenance dose.After one year of treatment with BDA 288 (78 per cent) of 371 patients with chronic asthma were well either without regular systemic corticosteroid therapy (33 per cent) or with only a small, and probably harmless maintenance dose of less than 5 mg of prednisolone per day. In patients previously on regular treatment with corticosteroids the introduction of BDA permitted a reduction in the mean maintenance dose of prednisolone from 8·5 mg to 3·3 mg per day.Although 6·5 per cent of the 400 patients treated with BDA developed oropharyngeal thrush and 3·2 per cent developed hoarseness, it was necessary to withdraw this treatment in only 10 of the 39 patients in whom these side effects were recorded.The results of this study indicate that aerosol corticosteroid therapy alone or supplemented by systemic corticosteroids in a dose small enough not to cause side effects can control the symptoms of chronic asthma in more than 75 per cent of patients. The study failed to identlfy any specific factors which could be used to predict an individual patient's response to BDA, and this treatment is therefore worth a trial in every case of
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