A comparative study of efficacy and safety of arformoterol and salbutamol nebulization as rescue therapy in acute non-severe asthma

Abstract

Arformoterol, a long-acting beta-2 agonist, has a rapid onset and long duration of action. Its role as rescue medication in acute asthma attack is undetermined. To compare the efficacy and tolerability of arformoterol with salbutamol nebulization, a study was conducted among 50 patients with acute non-severe asthma. Patients were randomly assigned to group 1 (n = 25) and group 2 (n = 25) who received three doses of salbutamol and arformoterol nebulization, respectively, at 20-min intervals. The peak expiratory flow rate (PEFR) was measured at the baseline and 5 min after each dose. The demographics and baseline characteristics were comparable between the two groups. The mean PEFR significantly increased in both these groups when compared with the baseline. The increases in the PEFR in two groups were similar after the third dose. The adverse effects in both these groups were minor. Arformoterol was as effective and safe as salbutamol in acute non-severe asthma.

A pharmacoepidemiological study of prescription patterns of β2 sympathomimetic bronchodilators in exacerbation of non-severe asthma in tertiary care hospitals, not needing hospitalization

“…18 As a clinically favorable bronchodilator, formoterol have both a rapid onset and long duration of action, with a wellcharted safety and tolerability profile. 19 So it can ideally be used as an alternative to short-acting β 2 agonists in the management of exacerbations of acute asthma as it causes rapid bronchodilatation, while reducing the need for frequent administration. Being hydrophilic drugs, salbutamol has an ability to reach the β 2 receptor from the aqueous phase, thus showing rapid onset of action while, formoterol is much more lipophilic than salbutamol.…”

“…[20][21][22] Just as salbutamol, onset of action of formoterol is 1-3 min; and after 5-10 min of inhalation, 80-90% of the bronchodilatation occurs; duration of action being 12 hours. 19 The other effects of formoterol on the airway, apart from bronchodilatation, are the inhibition of plasma leakage in the airways through the beta-2 receptor on the endothelial cells of post-capillary venules and sputum α-2 macro-globulin; and the inhibition of mediator release by mast cells, which is an important benefit in the treatment of asthma. 16,[23][24][25][26] Neutrophils are the key inflammatory cells in COPD.…”

“…16,28,29 The efficacy of long-acting beta-2 agonists, such as salmeterol and formoterol, in the maintenance therapy of chronic stable asthma (when used along with an inhaled corticosteroid) and also in acute non-severe asthma, acute severe asthma, exercise induced bronchospasm, childhood asthma and COPD are welldocumented. 10,18,19,30 Most studies show the use of formoterol with terbuhaler, aerolizer, or metered dose inhaler. But, there are very less studies showing the use of formoterol in the form of nebulization.…”

“…But, there are very less studies showing the use of formoterol in the form of nebulization. 19 Arformoterol can be used in patients who are unable or unwilling to use a dry powder inhalation (DPI) or metered dose inhaler (MDI) preparation. Other uses of arformoterol nebulized medication are seen in patients who have repeated episodes of airflow obstruction despite DPI / MDI use and in patients with severe lung function compromise.…”

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“…But, these have to be frequently administered, due to their short duration of action, which often causes inconvenience among the patients 7 . As a clinically favorable bronchodilator, formoterol have both a rapid onset and long duration of action, with a well-charted safety and tolerability profile 8 . So it can ideally be used as an alternative to short-acting β2 agonists in the management of exacerbations of acute asthma as it causes rapid bronchodilatation, while reducing the need for frequent administration.…”