Ciclesonid? or Ethnol? – Which is more effective for the COVID-19 medication treatment using Alvesco(R) as aerosol-type inhaled corticosteroids –

Hidenori Dokai M.D. Ph.DHiroaki Inomata M.D.


Japanese doctors have reported that an asthma drug Alvesco(R), aerosol-type inhaled corticosteroids (ICS), appears to be effective in reducing symptoms of coronavirus patients who developed pneumonia[1], although their report is written in Japanese and not peer-reviewed.

The report shows that the three patients were given Alvesco, whose main component is ciclesonid, in the regular manner using dedicated inhaler for the forming ciclesonid itself into aerosol on February 20 and their health improved in about two days.

In general, particles of the aerosol could be reached in alveoli of lungs, where  SARS-CoV-2 multiply and damage the surrounding tissues, when the mean diameter of particles in the aerosol is <2 micrometer[2]. This condition is thought to be satisfied in Alvesco[3].

Therefore, they speculate that ciclesonid in the state of aerosol reach the alveoli, suppress the virus multiplication and relieve the inflammation resulting in reducing symptoms of COVID-19 patients.

However, it is strange that no ICS drugs other than Alvesco are effective for COVID-19. According by the report[1], researchers in Japanese National Institute of Infectious Diseases (NIID ) had done many screening tests in vitro on other ICSs clinically available in Japan to confirm whether each of them suppress the virus multiplication resulting in vain except Alvesco. In addition ciclesonid itself seems to have no ability to suppress the virus multiplication though it have anti-inflammatory effect[4].

What is difference between Alvesco and other aerosol-type ICSs?

One of the clues to solve this problem might have been ethanol which is additive specific for Alvesco[5]. Assuming that ethanol destroyed the envelope of SARS-CoV-2 and ciclesonid suppressed inflammation induced by COVID-19, this assumption could be good explanation why only Alvesco among aerosol-type ICSs is effective for COVID-19.


Hidenori Dokai M.D. Ph.D
JPS Board Certified Pediatrician

Hiroaki Inomata M.D. B.A.


chemical structure formula and its 3D model


1) available at:

2) Rohatagi S, Derendorf H, Zech K. Risk-Benefit Value of Inhaled Corticosteroids: A Pharmacokinetic/Pharmacodynamic Perspective. Chest. 2003;123:430S-431S.

3) 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.

4) available at:

5) “Drug Delivery Systems” p553, Academic Press, Rakesh Tekade, ISBN: 9780128145081


Murakami Movies

I have heard that Harki Murakami’s short story ‘Hanalei Bay’ ( published in “Blind Willow, Sleeping Woman”) is made into movie.

The movie will be released October 19, 2018 in Japan.
You can watch first trailer for the film at YouTube.

Do you like murakami movies?

BiriBiri Sisters

Good animation works have been produced in Japan. ‘Toaru’ series is one of them.

index 2 story 17   10032 13577 & 10039 jealous Over MISAKA 19090

Misaka 10039
“She has obtained information such as receiving good luck when putting an engagement ring on your left ring finger,” leaks Misaka-10039, seeing the opportunity.
Miaka 19090
Ring…good luck…

index 2 story 17    Last order cheats Misaka 10032

Misak 20001 号
“Misaka wants that too!” whines Misaka as Misaka tries to throw atantrum like a spoiled child.
Misaka 10032
You may be trying to act cute, but that kind of behavior only annoys me,” says Misaka as Misaka explains gently.



BiriBiri sisters feelings for language are very unique. I love them !



A Book a patient against ECT wrote

Many people have criticized ECT (ElectroConvulsive Thrapy).

This is a book a depressive patient against ECT wrote.

Opinions of the author is classical.

‘somewhere but USA’ said like this in review

ECT techniques vary from country to country. For example, maximal charge of ECT device available in European countiries is over 1000mC whereas ones of most Asian countries are limited under 504mC.
So, practitioner in Asia try to optimize ECT parameters.
You should read 
Inomata H, Harima H, Itokawa M. A case of schizophrenia successfully treated by m-ECT using ‘long’ brief pulse. International Journal of Case Reports and Images 2012;3(7):30-34. 

We cannnot believe Sackeim is considered to be authority in the world. He has neither knowledge of biophysics nor medical license.

It’s exactly right.



How To build & run OsiriX on Xcode 4.3

I am a beginner of Mac computer. But I could managed to build OsiriX on Xcode 4.3 from the source codes .


So, I’ll give you some tips.

#1 Xcode 4.3 can use subversion (SVN) directly. It’s easier for the beginners to get the OsiriX source code from ‘repository’. (NO NEED to use ‘terminal’)

#2 Xcode 4.3 disregards ‘target’ concept and adopts ’scheme’ concept in order to build ‘product’ or ‘library’. You should set it up by selecting your desirable item using ‘Scheme’ selection box on the topleft of the panel.

Good Luck!

Welcome to PHAZOR.ORG

This is the site where biophysics meets medicine.

I am Hiroaki Inomata. I was born and raised in Japan. Firstly, I entered University of Tsukuba and majored in Physics. After the graduation, I worked for several organizations. Then, I re-entered medical school of Yokohama City University when I was 30. Now I am a psychiatric doctor.

So, I am interested in both physics and medicine and try to link the two in fascinating manners in this site.