Targeting small airways

One of the greatest benefits of Alvesco® is its small particle size, which enables it to enter the small airways (<2mm diameter) and reduce inflammation at these important sites.1 

Alvesco® is delivered via a pressurized metered-dose inhaler (pMDI) using a hydrofluoroalkane (HFA) propellant. Unlike other HFA pMDIs, many of which are formulated in suspension, Alvesco® is formulated as a solution aerosol. As a result, the majority of Alvesco® particles are very small (≤5µm)2 and highly respirable with an average droplet size (mass median aerodynamic diameter [MMAD]) of approximately 1µm (Figure 1).3

212 fig 1ICS particle sizes
Figure 1: Alvesco® has a small average particle size (MMAD)4

This small average particle size means that the total lung and small airway distribution of Alvesco® is high. Alvesco® offers a total lung deposition of 52%, of which 55% is distributed to the small airways (Figure 2), where it can act against underlying asthma inflammation.5 This compares favourably with other inhaled corticosteroids, such as budesonide DPI, which offers a total lung deposition of 19%, of which 38% is distributed to the small airways6 (Figure 2). The small particle size of Alvesco® also means that it exhibits low deposition in the oropharynx,7 which helps to minimize local side effects.8

212 fig 2Alvesco versus budesonide
Figure 2: Alvesco® achieves a high total lung deposition, of which more than half is distributed to the small airways. Data from Newman S, et al 20065 and Hirst PH, et al 2001.6


  1. Hoshino M. Comparison of effectiveness in ciclesonide and fluticasone propionate on small airway function in mild asthma. Allergol Int 2010;59:59-66.
  2. de Vries TW, Rottier BL, Gjaltema D, et al. Comparative in vitro evaluation of four corticosteroid metered dose inhalers: Consistency of delivered dose and particle size distribution. Respir Med 2009;103:1167-73.
  3. Leach CL, Bethke TD, Boudreau RJ, et al. Two-dimensional and three-dimensional imaging show ciclesonide has high lung deposition and peripheral distribution: a nonrandomized study in healthy volunteers. J Aerosol Med 2006;19:117-26.
  4. Nave R, Mueller H. From inhaler to lung: clinical implications of the formulations of ciclesonide and other inhaled corticosteroids. Int J Gen Med 2013;6:99-107.
  5. Newman S, Salmon A, Nave R, et al. High lung deposition of 99mTc-labeled ciclesonide administered via HFA-MDI to patients with asthma. Respir Med 2006;100:375-84.
  6. Hirst PH, Bacon RE, Pitcairn GR, et al. A comparison of the lung deposition of budesonide from Easyhaler, Turbuhaler and pMDI plus spacer in asthmatic patients. Respir Med 2001;95:720-7.
  7. Richter K, Kanniess F, Biberger C, et al. Comparison of the oropharyngeal deposition of inhaled ciclesonide and fluticasone propionate in patients with asthma. J Clin Pharmacol 2005;45:146-52.
  8. Bateman ED, Linnhof AE, Homik L, et al. Comparison of twice-daily inhaled ciclesonide and fluticasone propionate in patients with moderate-to-severe persistent asthma. Pulm Pharmacol Ther 2008;21:264-75.
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