Improved asthma control with budesonide/formoterol in a single inhaler, compared with budesonide alone

Abstract

Budesonide/formoterol in a single inhaler was compared with budesonide alone, and with concurrent administration of budesonide and formoterol from separate inhalers, in patients with asthma, not controlled with inhaled glucocorticosteroids alone.In this 12-week, double-blind, randomized, double-dummy study, 362 adult asthmatics (forced expiratory volume in one second 73.8% of predicted, inhaled glucocorticosteroid dose 960 mg?day -1 ) received single inhaler budesonide/formoterol (Symbicort1 Turbuhaler1) 160/4.5 mg, two inhalations b.i.d., or corresponding treatment with budesonide, or budesonide plus formoterol via separate inhalers.There was a greater increase in morning peak expiratory flow (PEF) with singleinhaler (35.7 L?min -1 ) and separate-inhaler (32.0 L?min -1 ) budesonide and formoterol, compared with budesonide alone (0.2 L?min -1 ; pv0.001, both comparisons); the effect was apparent after 1 day (pv0.001 versus budesonide, both comparisons). Similarly, evening PEF, use of rescue medication, total asthma symptom scores and percentage of symptom-free days improved more with both single inhaler and separate inhaler therapy than with budesonide alone, as did asthma control days (y15% more, pv0.001 versus budesonide, both comparisons, with a marked increase in the first week). All treatments were well tolerated and the adverse event profile was similar in all three treatment groups.It is concluded that single inhaler therapy with budesonide and formoterol is a clinically effective and well-tolerated treatment for patients with asthma that is not fully controlled by inhaled glucocorticosteroids alone.

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

“…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].…”

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

“…KEYWORDS: Asthma, budesonide/formoterol, salmeterol/fluticasone, Seretide H /Advair H , Symbicort H C ombination therapy with inhaled corticosteroids (ICS) and a long-acting b 2 -agonist (LABA) represents a major improvement in the treatment of asthma [1][2][3][4], and is now used increasingly as fixed-combination therapy [5]. In addition to being more convenient than separate inhalers, combination inhalers control asthma at lower doses of ICS compared with ICS alone [6,7] and may prevent patients from over-relying on their LABA or short-acting b 2 -agonist (SABA) at the expense of ICS therapy.…”

Formoterol as relief medication in asthma: the jury is still out

“…The possibility that formoterol could be used in exacerbations both to relieve increasing asthma symptoms and to achieve more rapid control of deteriorating asthma is suggested by the relatively fast response when LABA are added as regular medication for patients who are symptomatic on ICS alone [5][6][7][8]. In vitro studies and some clinical studies also suggest a synergistic effect for LABA with ICS that may be advantageous during asthma exacerbations and periods of poor asthma control [19][20][21].…”

“…Early studies demonstrated no increase in asthma exacerbations when added to inhaled corticosteroids (ICS) as long-term maintenance medication and subsequent studies have shown significantly reduced risks of exacerbations and improved, more rapid establishment of asthma control compared to adding more ICS [3][4][5]. Formoterol is a potent LABA with a rapid onset of bronchodilatation [6,7] and a relatively fast clinical response when added as regular medication for patients who are symptomatic on ICS alone [5,8,9]. The question therefore arises, could formoterol with its rapid onset of action, also be used safely and effectively as reliever medication for asthma [10]?…”