Comparison of second controller medications in addition to inhaled corticosteroid in patients with moderate asthma

Abstract

The objective of this study was to compare the efficacy and safety of the second controller medications (long-acting beta2-agonist, leukotriene receptor antagonist and sustained-release theophylline) used in addition to inhaler corticosteroid treatment in moderate persistent asthma. A total of 64 patients with asthma, in the moderate persistent asthma category, were divided into three groups. Patients, all of whom were concurrently using inhaled corticosteroid (Budesonide 400 microg twice daily), were treated for 3 months with either inhaled formoterol 9 microg twice daily (first group), oral zafirlukast 20 mg twice daily (second group), or sustained-release theophylline 400 mg once daily (third group). All of the patients were subjected to assessments on the subject of peak expiratory flow (PEF) variability, forced expiratory volume in 1 sec (FEV1), asthma symptom scores (daytime and night-time), supplemental terbutalin use, asthma exacerbations and adverse events. Over the 3-month treatment period. In all of the three groups, significant improvements were recorded in the lung function, asthma symptom scores and supplemental terbutalin use criteria, as a result oftreatments applied. Formoterol treatment resulted in significantly greater and earlier improvements compared with the other two groups in several criteria: PEF variability (17.9 +/- 2.5; 21.9 +/- 3.2; 23.7 +/- 3.3; P < 0.001); asthma symptom score (daytime) (1.6 +/- 0.5; 1 +/- 0.5; 2.0 +/- 0,5; P < 0.05); asthma symptom score (night-time) (1.2 +/- 0.4; 2.2 +/- 0.5; 16 +/- 0.6; P < 0001); and supplement alter butalin use (1.2 +/- 0.3; 1.8 +/- 0.5; 1.7 +/- 0.5; P < 0.05). However, at the end of the treatment, in all of the three groups studied, improvements were attained in overall asthma control and there was no statistical difference among the groups. Although there were no side effects which required the discontinuation of the treatment, it was observed that the maximum side effect was in the second group (20%, 31.6% and 20%, respectively). In conclusion, in patients who still have symptoms on treatment with inhaled corticosteroids, the addition of a long-acting beta2-agonist, leukotriene antagonists or sustained-release theophylline to the treatment is a logical approach, and, in addition to inhaled corticosteroids, any one of these second controller medications may be chosen in patients with moderate asthma.

Comparison of Leukotriene Receptor Antagonist and Theophylline in Addition to Inhaled Corticosteroid in Adult Asthma: A Meta-Analysis

“…No signifi cant inter-study heterogeneity was found (I 2 =0, p=0.80). Mean change in number of daily short β 2 -agonist use: 166 patients from three studies were considered for this analysis (82 treated with ICS plus LTRA, 84 treated with ICS plus theophylline) (Yurdakul et al, 2002;Tsuchida et al, 2005;Shah et al, 2006). There was no signifi cant difference between ICS plus LTRA and ICS plus theophylline therapy in reducing the number of dailyβ2-agonist use in asthmatics (mean difference 0.04 [95% CI -0.30-0.38], p=0.82) (Fig.…”

“…No signifi cant interstudy heterogeneity was found (I 2 =0, p=0.56). Asthma exacerbations: Data on asthma exacerbations were available in two trials (49 treated with ICS plus LTRA, 50 treated with ICS plus theophylline) (Yurdakul et al, 2002;Shah et al, 2006). Asthma exacerbations were almost equal between ICS plus LTRA and ICS plus theophylline therapy in asthmatics (pooled OR 1.00 [95% CI 0.23-4.38], p=1.00) (Fig.…”

“…Adverse eff ects: 99 patients from two studies were considered for this analysis (49 treated with ICS plus LTRA, 50 treated with ICS plus theophylline) (Yurdakul et al, 2002;Shah et al, 2006). There was no major adverse reactions noted, and no signifi cant difference between ICS plus LTRA and ICS plus theophylline therapy in minor adverse events in asthmatics (pooled OR 1.41 [95% CI 0.48-4.16], p=0.53) (Fig.…”

“…After independent review, four RCTs including the comparison of LTRA and theophylline in addition to ICS in asthmatic adults were considered to be eligible for inclusion in the analysis (Dempsey et al, 2002;Yurdakul et al, 2002;Tsuchida et al, 2005;Shah et al, 2006), all available for analysis, and their characteristics are listed in Table 1. Totally, 90 patients were randomly assigned to LTRA addition to ICS and 92 patients were assigned to theophylline addition to ICS groups.…”

Study protocol for assessment of various second-line treatment regimens on persistent asthmatic patients - A randomized active controlled trial

“…Measurement of the asthma symptom score is one of the most important outcome measure reported by the patients in order to assess, their feeling about asthma [19,20]. Both day-time and night-time asthma symptom scores will be noted.…”