Budesonide/formoterol maintenance and reliever therapy: impact on airway inflammation in asthma

Abstract

The aim of the present study was to compare the effectiveness, safety and health economics of budesonide/formoterol maintenance and a novel reliever therapy with conventional best practice in patients with persistent asthma in Canada.After 2 weeks of usual therapy, 1,538 patients were randomised for 6 months to open-label budesonide/formoterol maintenance and reliever therapy 160/4.5 mg twice daily and as needed, or to guideline-based conventional best practice. Severe asthma exacerbations, reliever medication use and total inhaled corticosteroid dose were analysed in all patients and airway inflammation was assessed in a sub-study of 115 patients.No differences were seen in time to first severe exacerbation and severe asthma exacerbation rate. There were numerically fewer emergency room visits or hospitalisations with budesonide/ formoterol maintenance and reliever therapy (4.4 versus 7.5 events per 100 patients?yr -1 , 41% reduction); however, this did not reach statistical significance. Mean total inhaled corticosteroid dose, reliever use, asthma medication costs and total annual costs per patient were all significantly lower with budesonide/formoterol maintenance and reliever therapy. Mean sputum eosinophil cell counts remained in the range for controlled inflammation in both groups.In conclusion, budesonide/formoterol maintenance and reliever therapy achieved similar or improved clinical control compared with conventional best practice, with significantly lower total inhaled corticosteroid dose and lower cost, while maintaining similar control of eosinophilic inflammation.

Sensitivity of disease parameters to flexible budesonide/formoterol treatment in an allergic rat model

“…The lung weight values reflect lung inflammatory oedema while the values for ELGV reflect the severity of bronchoconstriction, mucus plugging, and also to a certain extent, oedema [8]. We have also observed that the inflammatory as compared to 5% decrease (p=0.97) by conventional best practice therapy (based on maintenance dosing) [12].…”

Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma

“…For these Figure 6. Change in sputum eosinophil count in patients receiving budesonide/formoterol as maintenance and reliever therapy or conventional best practice (71). Patients in the budesonide/ formoterol maintenance and reliever therapy group received 748 lg/day ICS in BDP equivalents and patients in the conventional best practice (CBP) treatment group received 1015 lg/day ICS in BDP equivalents (P < 0.0001).…”

“…Sears et al conducted a study in a subgroup of patients to examine the changes in induced sputum eosinophil count in patients receiving budesonide/formoterol maintenance and reliever therapy (160/4.5 lg b.i.d.) compared with conventional best practice and concluded that budesonide/formoterol maintenance and reliever therapy achieved similar control of eosinophilic inflammation compared with conventional best practice, despite a lower mean ICS dose (71) (Fig. 6).…”

“…Patients in the budesonide/ formoterol maintenance and reliever therapy group received 748 lg/day ICS in BDP equivalents and patients in the conventional best practice (CBP) treatment group received 1015 lg/day ICS in BDP equivalents (P < 0.0001). Reprinted from Sears et al (71); adapted with permission from European Respiratory Society Journals. BUD/FORM, budesonide/formoterol.…”

Feste Kombination aus Budesonid und Formoterol in der Erhaltungs- und Bedarfstherapie

“…Diese und andere synergistische Wirkungen von Budesonid und Formoterol tragen mit Wahrscheinlichkeit zu den beobachteten positiven Effekten der festen Budesonid-Formoterol-Kombination in der Erhaltungs-und Bedarfstherapie bei (Übersichten bei [12,39]). Eine kanadische Untersuchung belegt darüber hinaus, dass eine SMART-Therapie trotz des geringeren Bedarfs an Glukokortikoiden selbst einer optimalen konventionellen Asthmatherapie im Hinblick auf Parameter der asthmatischen Schleimhautentzündung zumindest gleichwertig ist [40].…”