Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids.

Woolcock, Ann J.; Lundbäck, Bo; Ringdal, N.; Jacques, Loretta

doi:10.1164/ajrccm.153.5.8630590

Cited by 650 publications

(352 citation statements)

References 20 publications

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“…The current recommendation is to add LABA to ICS as supported by studies that show no further benefit of doubling the low dose of ICS and the benefit of adding LABA to low-dose ICS. The benefits of combination therapy therefore include a reduction in the rate of asthma exacerbations and prevention of exacerbations with improvement in most indicators of asthma control [114,[125][126][127][128]. In the FACET study, a four-fold increase in the dose of ICS (budesonide 200 μg/day to 800 μg/day) improved all asthma outcomes; addition of LABA to 800 μg/day budesonide provided the greatest benefit, with a maximum four-fold reduction in exacerbation rate compared to the budesonide 200 μg/day treatment arm [129].…”

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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“…Complementary action of long-acting b 2 -agonists with medium or high doses of inhaled GCS has been reported in moderately severe asthma in terms of both improvement in lung function and prevention of asthma exacerbation (77,78). Such benefits have been shown to persist for up than one year.…”

Section: Long-acting B-adrenergic Agonistsmentioning

confidence: 99%

Difficult asthma

Garcia

and

Humbert

2003

Allergy

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“…In a study of 738 patients not well controlled on high doses of inhaled beclomethasone (500 mcg twice a day), the addition of a long-acting inhaled β-2 agonist (in two different doses of 50 mcg bid and 100 mcg bid) was compared to doubling the dose of the inhaled corticosteroid. The groups that were treated with the longacting β-2 agonist significantly improved a.m. and p.m. PEFR as well as more symptom-free and rescue-medication-free days and nights (131). No difference was observed between the groups treated with the different doses of long-acting β-2 agonist.…”

Section: Pulmonary Medicine and Critical Care Asthmamentioning

confidence: 86%

Update in Internal Medicine

López-Jiménez

Brito

Aude

et al. 2000

Archives of Medical Research

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More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes.Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.

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Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids.

Cited by 650 publications

References 20 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

Difficult asthma

Update in Internal Medicine

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