Formoterol used as needed in patients with intermittent or mild persistent asthma

Чучалин, А. Г.; Kasl, Milan; Bengtsson, Thomas; Nihlén, Ulf; Rosenborg, Johan

doi:10.1016/j.rmed.2004.09.012

Cited by 13 publications

(35 citation statements)

References 21 publications

(22 reference statements)

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“…A total of 22,604 participants were randomised to eight eligible studies (Ind 2002; Jain 2004; Rabe 2006; RELIEF 2003; SD-037-0714; SD-037-0716; Tattersfield 2001; Villa 2002). The largest trial was RELIEF 2003 with 17,862 participants, whilst Rabe 2006 had 2281 participants and the remaining six trials had between 60 and 675 participants.…”

Section: Resultsmentioning

confidence: 99%

“…The largest trial was RELIEF 2003 with 17,862 participants, whilst Rabe 2006 had 2281 participants and the remaining six trials had between 60 and 675 participants. The trials were also of different lengths with a mean duration of 29.5 weeks; three trials were 12 months long (Rabe 2006; SD-037-0714; SD-037-0716), three were six months long (Jain 2004; RELIEF 2003; Villa 2002) and two were three months long (Ind 2002; Tattersfield 2001).…”

Section: Resultsmentioning

confidence: 99%

“…Two trials (Ind 2002; Tattersfield 2001) were conducted in adults, one in children (Villa 2002), four trials (Rabe 2006; RELIEF 2003;SD-037-0714; SD-037-0716) were conducted in adults and children and it was unclear in what population Jain 2004 was conducted. Participants with a range of different asthma severities across studies were enrolled.…”

Section: Resultsmentioning

confidence: 99%

“…Participants with a range of different asthma severities across studies were enrolled. The largest study (RELIEF 2003) allowed any severity of asthma, whilst Rabe 2006 allowed moderate to severe, Tattersfield 2001 and Villa 2002 allowed mild-moderate, SD-037-0714 participants had mild asthma and SD-037-0716 had intermittent asthma.…”

Section: Resultsmentioning

confidence: 99%

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Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma

Welsh

Cates

2010

Cochrane Database of Systematic Reviews

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Background Formoterol is a long-acting beta2-agonist but because it has a fast onset of action it can also be used as a relief medication. Objectives To asses the efficacy and safety of formoterol as reliever therapy in comparison to short-acting beta2-agonists in adults and children with asthma. Search methods We searched the Cochrane Airways Group Specialised Register and websites of clinical trial registers (for unpublished trial data), and we checked the Food and Drug Administration (FDA) submissions in relation to formoterol. The date of the most recent search was February 2010. Selection criteria Randomised, parallel-arm trials of at least 12 weeks duration in patients of any age and severity of asthma. Studies randomised patients to any dose of as-needed formoterol versus short-acting beta2-agonist. Concomitant use of inhaled corticosteroids or other maintenance medication was allowed, as long as this was not part of the randomised treatment regimen. Data collection and analysis Two authors independently selected trials for inclusion in the review. Outcome data were extracted by one author and checked by the second author. We sought unpublished data on primary outcomes. Main results This review includes eight studies conducted in 22,604 participants (mostly adults). Six studies compared formoterol as-needed to terbutaline whilst two studies compared formoterol with salbutamol as-needed. Background maintenance therapy varied across the trials. Asthma exacerbations and serious adverse events showed a direction of treatment effect favouring formoterol, of which one outcome reached statistical significance (exacerbations requiring a course of oral corticosteroids). In patients on short-acting beta2-agonists, 117 people out of 1000 had exacerbations requiring oral corticosteroids over 30 weeks, compared to 101 (95% CI 93 to 108) out of 1000 for patients on formoterol as-needed. In patients on maintenance inhaled corticosteroids there were also significantly fewer exacerbations requiring a course of oral corticosteroids on formoterol as-needed (Peto OR 0.75; 95% CI 0.62 to 0.91). There was one death per 1000 people on formoterol or on short-acting beta2-agonists. Authors’ conclusions In adults, formoterol was similar to short-acting beta2-agonists when used as a reliever, and showed a reduction in the number of exacerbations requiring a course of oral corticosteroids. Clinicians should weigh the relatively modest benefits of formoterol as-needed against the benefits of single inhaler therapy and the potential danger of long-term use of long-acting beta2-agonists in some patients. We did not find evidence to recommend changes to guidelines that suggest that long-acting beta2-agonists should be given only to patients already taking inhaled corticosteroids. There was insufficient information reported from children in the included trials to come to any conclusion on the safety or efficacy of formoterol as relief medication for children with asthma.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma

Welsh

Cates

2010

Cochrane Database of Systematic Reviews

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“…Compared to albuterol use on an as‐needed basis, scheduled doses of albuterol demonstrated no benefit (Walters, Walters, & Gibson, 2002). Recent studies have reported equivocal results with use of the LABA formoterol for quick relief therapy in children (Chuchalin, Kasl, Bengtsson, Nihlen, & Rosenborg, 2005; Hermansen et al, 2006). LABA may be used to prevent EIB; however, NAEPP‐EPR3 discourages their use in this application.…”

Section: Pharmacologic Interventions: Long‐term Control Of Inflammatimentioning

confidence: 99%

Outpatient management of asthma in children age 5–11 years: Guidelines for practice

Watts¹

2009

Journal of the American Academy of Nurse Practitioners

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Inhaled Reliever Therapies for Asthma

Rayner,

Ferri,

Guyatt

et al. 2024

JAMA

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ImportanceThe optimal inhaled reliever therapy for asthma remains unclear.ObjectiveTo compare short-acting β agonists (SABA) alone with SABA combined with inhaled corticosteroids (ICS) and with the fast-onset, long-acting β agonist formoterol combined with ICS for asthma.Data SourcesThe MEDLINE, Embase, and CENTRAL databases were searched from January 1, 2020, to September 27, 2024, without language restrictions.Study SelectionPairs of reviewers independently selected randomized clinical trials evaluating (1) SABA alone, (2) ICS with formoterol, and (3) ICS with SABA (combined or separate inhalers).Data Extraction and SynthesisTwo reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses synthesized outcomes. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the certainty of evidence.Main Outcomes and MeasuresAsthma symptom control (5-item Asthma Control Questionnaire; range, 0-6, lower scores indicate better asthma control; minimum important difference [MID], 0.5 points), asthma-related quality of life (Asthma Quality of Life Questionnaire; range, 1-7, higher scores indicate better quality of life; MID, 0.5 points), risk of severe exacerbations, and risk of serious adverse events.ResultsA total of 27 randomized clinical trials (N = 50 496 adult and pediatric patients; mean age, 41.0 years; 20 288 male [40%]) were included. Compared with SABA alone, both ICS-containing relievers were associated with fewer severe exacerbations (ICS-formoterol risk ratio [RR], 0.65 [95% CI, 0.60-0.72]; risk difference [RD], −10.3% [95% CI, −11.8% to −8.3%]; ICS-SABA RR, 0.84 [95% CI, 0.73-0.95]; RD, −4.7% [95% CI, −8.0% to −1.5%]) with high certainty. Compared with SABA alone, both ICS-containing relievers were associated with improved asthma control (ICS-formoterol RR improvement [MID] in total score, 1.07 [95% CI, 1.04-1.10]; RD, 4.1% [95% CI, 2.3%-5.9%]; ICS-SABA RR, 1.09 [95% CI, 1.03-1.15]; RD, 5.4% [95% CI, 1.8%-8.5%]) with high certainty. In an indirect comparison with ICS-SABA, ICS-formoterol was associated with fewer severe exacerbations (RR, 0.78 [95% CI, 0.66-0.92]; RD, −5.5% [95% CI, −8.4% to −2.0%]) with moderate certainty. Compared with SABA alone, ICS-formoterol (RD, −0.6% [95% CI, −1.3% to 0%]) was not associated with increased risk of serious adverse events (high certainty) and ICS-SABA (RD, 0% [95% CI, −1.1% to 1.2%]) was not associated with increased risk of serious adverse events (moderate certainty).Conclusions and RelevanceIn this network meta-analysis of patients with asthma, ICS combined with formoterol and ICS combined with SABA were each associated with reduced asthma exacerbations and improved asthma control compared with SABA alone.

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Formoterol used as needed in patients with intermittent or mild persistent asthma

Abstract: Formoterol 4.5 microg used as needed was at least as effective and safe as terbutaline 0.5 mg used as needed in intermittent and mild persistent asthma, and was associated with less systemic effects when administered as high single doses.

Cited by 13 publications

References 21 publications

Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma

Formoterol versus short-acting beta-agonists as relief medication for adults and children with asthma

Outpatient management of asthma in children age 5–11 years: Guidelines for practice

Inhaled Reliever Therapies for Asthma

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