Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

Vogelmeier, Claus; D’Urzo, Anthony; Pauwels, Romain; Merino, J M; Jaspal, M; Boutet, S; Naya, Ian; Price, David

doi:10.1183/09031936.05.00028305

Cited by 193 publications

(226 citation statements)

References 32 publications

(41 reference statements)

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“…More recent work has suggested that when treatment reduction is indicated it is best to reduce the glucocorticoid dose rather than remove the LABA [134]. Currently, overall, there is no clear clinical evidence that suggests that one drug combination is better than the other in the short term [135] although differences in the device may be important in lung deposition in asthmatic patients with poor inspiratory flow [136] and treatment regimes may benefit some patients over others [125,133,137,138]. Indeed, the recent demonstration that the combination of formoterol/beclomethasone in a single inhaler is equivalent to formoterol/budesonide and salmeterol/ fluticasone with respect to asthma control, rates of asthma exacerbations and frequency of adverse events emphasises this point [139][140][141].…”

Section: Moderate Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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Section: Moderate Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

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“…Kuna et al (44) reported similar clinically relevant improvements in overall AQLQ scores (increases of 0.76-0.78) and in scores from each of the AQLQ domains with budesonide/formoterol maintenance and reliever therapy compared with higher fixed doses of ICS/LABA plus SABA. In a dose-titration study conducted by Vogelmeier et al (46) designed to mirror the real-life clinical setting, similar and clinically relevant increases in overall AQLQ score from run-in (0.57-0.60) were reported. Changes in AQLQ were not significantly different between the treatment groups.…”

Section: Improving Daily Asthma Control and Reducing Impairmentmentioning

confidence: 95%

“…Using this definition of asthma control, Buhl and Vogelmeier (49) reported equivalent control with budesonide/formoterol maintenance and reliever therapy compared with fixed-dose ICS/LABA plus SABA. In a dose-titration study, a greater proportion of patients (76% vs 66%) achieved well-controlled asthma with budesonide/ formoterol maintenance and reliever therapy compared with salmeterol/fluticasone plus SABA, and with higher probability of achieving this level of control (odds ratio 1.68; 95% CI 1.38-2.05; P < 0.001) (46). Periods with high reliever use, indicating poorly controlled asthma, are a risk factor for life-threatening asthma (50).…”

Section: Improving Daily Asthma Control and Reducing Impairmentmentioning

confidence: 99%

“…An overview of these clinical trials is provided in Table 1 and they are individually discussed in detail elsewhere (35,(42)(43)(44)(45)(46)(47).…”

Section: Formoterol As a Fast-acting Relievermentioning

confidence: 99%

“…Evidence of the efficacy and safety of maintenance and reliever therapy with budesonide/formoterol Five large-scale, double-blind clinical trials and one openlabel, dose-titration study, of 6-12 months duration and including over 15 000 asthma patients aged ‡ 12 years, have demonstrated the superior efficacy and safety of budesonide/formoterol maintenance and reliever therapy compared with two-to fourfold higher doses of ICS (budesonide) plus SABA (35,42,43) and similar or higher doses of maintenance budesonide/formoterol (35,44,45) or salmeterol/fluticasone (44,46,47) plus SABA as needed. An overview of these clinical trials is provided in Table 1 and they are individually discussed in detail elsewhere (35,(42)(43)(44)(45)(46)(47).…”

Section: Formoterol As a Fast-acting Relievermentioning

confidence: 99%

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

Humbert

Andersson

Buhl³

2008

Allergy

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The Global Initiative for Asthma (GINA) guidelines aim at improving asthma control and preventing future risk. For patients with moderate to severe asthma an inhaled corticosteroid (ICS) or an ICS/long‐acting β2‐agonist (LABA) combination with a short‐acting β2‐agonist (SABA) as reliever is recommended. Despite the availability of effective maintenance therapies, a large proportion of patients still fail to achieve guideline‐defined asthma control, and overuse of SABA reliever medication at the expense of ICS is commonly observed. New simplified treatment approaches may offer a solution and assist physicians to achieve overall asthma control. One such treatment approach, which is recommended in the GINA guidelines, is budesonide/formoterol for both maintenance and reliever therapy. This treatment strategy significantly reduces the rate of severe asthma exacerbations compared with ICS/LABA plus SABA and achieves equivalent daily symptom control compared with higher doses of ICS/LABA plus separate SABA for relief. These benefits are achieved at a lower overall steroid load, and budesonide/formoterol maintenance and reliever therapy is well tolerated in patients with moderate to severe asthma. This review discusses current asthma management in patients with moderate to severe disease and examines the evidence for alternative asthma management approaches.

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Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma

Brožek¹,

Kraft²,

Krishnan³

et al. 2012

Arch Intern Med

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Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

Cited by 193 publications

References 32 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

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

Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma

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Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

Cited by 193 publications

References 32 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

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

Long-Acting β2-Agonist Step-off in Patients With Controlled Asthma

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Long-Acting β₂-Agonist Step-off in Patients With Controlled Asthma