A Comparison of Budesonide/Formoterol Maintenance and Reliever Therapy Versus Conventional Best Practice in Asthma Management in Spain

Quirce, Santiago; Barcina, Carlos; Plaza, Vicente; Calvo, Eduardo; Muñoz, Mercedes; Ampudia, Rubén; Capel, Margarita

doi:10.3109/02770903.2011.611954

Cited by 21 publications

(14 citation statements)

References 29 publications

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“…A previous clinical appraisal that compared antiinflammatory reliever and maintenance therapy and fixeddose regimens reported improvements that were attributed to patients who received additional ICS therapy administered in response to symptom requirements. 19 However, in the present real-world study and previous studies, 13,[23][24][25] the average amount of ICS used was lower for patients who received budesonide/formoterol than a conventional fixed-dose strategy, even though better treatment efficacy and health benefits were achieved. This is most likely explained by appropriate and timely ICS use with budesonide/formoterol anti-inflammatory reliever and maintenance therapy, which meets patients' expectations for effectiveness and simplifies their treatment in terms of a single inhaler.…”

contrasting

confidence: 61%

Budesonide/Formoterol Anti-Inflammatory Reliever and Maintenance or Fluticasone Propionate/Salmeterol Plus As-Needed, Short-Acting β2 Agonist: Real-World Effectiveness in pAtients without Optimally Controlled asThma (REACT) Study

Cheng¹,

Ho²,

Lai³

et al. 2020

DDDT

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contrasting

confidence: 61%

Budesonide/Formoterol Anti-Inflammatory Reliever and Maintenance or Fluticasone Propionate/Salmeterol Plus As-Needed, Short-Acting β2 Agonist: Real-World Effectiveness in pAtients without Optimally Controlled asThma (REACT) Study

Cheng¹,

Ho²,

Lai³

et al. 2020

DDDT

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“…The systematic review report for this topic also included five open-label, real-world clinical trials that compared daily budesonide-formoterol (160-320/4.5-9 mg) plus budesonideformoterol reliever therapy (SMART) with conventional best practice treatment (total N 5 5056). 6,[161][162][163][164] Active management levels varied in these studies. Because of the heterogeneity of the studies and lack of information regarding the type of therapy prescribed and used in the conventional best practice arms, the formal systematic review report did not include these studies.…”

Section: Rationale and Discussionmentioning

confidence: 99%

2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group

Cloutier

Baptist

Blake

et al. 2020

Journal of Allergy and Clinical Immunology

552

340

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The 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was coordinated and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. It is designed to improve patient care and support informed decision making about asthma management in the clinical setting. This update addresses six priority topic areas as determined by the state of the science at the time of a needs assessment, and input from multiple stakeholders: Fractional Exhaled Nitric Oxide Testing Indoor Allergen Mitigation Intermittent Inhaled Corticosteroids Long-Acting Muscarinic Antagonists Immunotherapy in the Treatment of Allergic Asthma Bronchial Thermoplasty A rigorous process was undertaken to develop these evidence-based guidelines. The Agency for Healthcare Research and Quality’s (AHRQ) Evidence-Based Practice Centers conducted systematic reviews on these topics, which were used by the Expert Panel Working Group as a basis for developing recommendations and guidance. The Expert Panel used GRADE (Grading of Recommendations, Assessment, Development and Evaluation), an internationally accepted framework, in consultation with an experienced methodology team for determining the certainty of evidence and the direction and strength of recommendations based on the evidence. Practical implementation guidance for each recommendation incorporates findings from NHLBI-led patient, caregiver, and clinician focus groups. To assist clincians in implementing these recommendations into patient care, the new recommendations have been integrated into the existing Expert Panel Report-3 (EPR-3) asthma management step diagram format.

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“…51 52 Overall, 64 reports describing 66 trials containing 59 622 patient years were included in the analysis (also see web extra table S1) 45 6 8 9 11 44 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 Of the 13 corresponding authors contacted, three provided additional data.…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis

Loymans

Gemperli

Cohen

et al. 2014

BMJ

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Objective To determine the comparative effectiveness and safety of current maintenance strategies in preventing exacerbations of asthma.Design Systematic review and network meta-analysis using Bayesian statistics.Data sources Cochrane systematic reviews on chronic asthma, complemented by an updated search when appropriate.Eligibility criteria Trials of adults with asthma randomised to maintenance treatments of at least 24 weeks duration and that reported on asthma exacerbations in full text. Low dose inhaled corticosteroid treatment was the comparator strategy. The primary effectiveness outcome was the rate of severe exacerbations. The secondary outcome was the composite of moderate or severe exacerbations. The rate of withdrawal was analysed as a safety outcome.Results 64 trials with 59 622 patient years of follow-up comparing 15 strategies and placebo were included. For prevention of severe exacerbations, combined inhaled corticosteroids and long acting β agonists as maintenance and reliever treatment and combined inhaled corticosteroids and long acting β agonists in a fixed daily dose performed equally well and were ranked first for effectiveness. The rate ratios compared with low dose inhaled corticosteroids were 0.44 (95% credible interval 0.29 to 0.66) and 0.51 (0.35 to 0.77), respectively. Other combined strategies were not superior to inhaled corticosteroids and all single drug treatments were inferior to single low dose inhaled corticosteroids. Safety was best for conventional best (guideline based) practice and combined maintenance and reliever therapy.Conclusions Strategies with combined inhaled corticosteroids and long acting β agonists are most effective and safe in preventing severe exacerbations of asthma, although some heterogeneity was observed in this network meta-analysis of full text reports. IntroductionAsthma is a widespread chronic airway disease characterised by an unpredictable course.1 Preventing exacerbations is considered a major long term treatment goal in international guidelines.1 These episodes of sudden deterioration of symptoms and airways obstruction result in a burden to the patient and use of expensive medical resources. Asthma related healthcare expenses in patients with exacerbations are double ($1740 (£1035; €1257) v $847) those of patients without exacerbations. Although inhaled corticosteroids-anti-inflammatory controller drugs-are currently the cornerstone of preventing asthma exacerbations, 4-6 several other agents or combination strategiesCorrespondence to: R J B Loymans r.j.loijmans@amc.nl Extra material supplied by the author (see http://www.bmj.com/content/348/bmj.g3009?tab=related#webextra) Table S1: data from included studies Table S2: risk of bias assessment of included studies Table S3: reported harms in included studies Figure S1: analysis with non-imputed data Figure S2: sensitivity analyses for severe exacerbations Figure S3: funnel plots of direct comparisons with five or more studies, for severe exacerbationsNo commercial reuse: See rights and repr...

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A Comparison of Budesonide/Formoterol Maintenance and Reliever Therapy Versus Conventional Best Practice in Asthma Management in Spain

Abstract: A simplified regimen using budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) was at least as effective at improving clinical control compared with CBP with a significantly lower ICS dose and lower drug costs.

Cited by 21 publications

References 29 publications

<p>Budesonide/Formoterol Anti-Inflammatory Reliever and Maintenance or Fluticasone Propionate/Salmeterol Plus As-Needed, Short-Acting β<sub>2</sub> Agonist: Real-World Effectiveness in pAtients without Optimally Controlled asThma (REACT) Study</p>

<p>Budesonide/Formoterol Anti-Inflammatory Reliever and Maintenance or Fluticasone Propionate/Salmeterol Plus As-Needed, Short-Acting β<sub>2</sub> Agonist: Real-World Effectiveness in pAtients without Optimally Controlled asThma (REACT) Study</p>

2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group

Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis

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