Onset of Bronchodilation of Budesonide/Formoterol vs. Salmeterol/Fluticasone in Single Inhalers

Palmqvist, Mona; Arvidsson, Peter; Beckman, Ola; Peterson, Stefan; Lötvall, Jan

doi:10.1006/pupt.2000.0260

Cited by 102 publications

(52 citation statements)

References 17 publications

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“…113 Onset of bronchodilation with FF is within 2-3 minutes whereas the onset of bronchodilation with SAL takes approximately 10 minutes and the maximal effect may not be apparent for several hours. 114 FF is more lipophilic than SAL and has a much higher degree of intrinsic agonist activity. 115 In addition to bronchodilator effects, LABAs also provide protection from a number of stimuli causing bronchial hyper-responsiveness, such as methacholine, cold air, exercise, hyperventilation and histamine.…”

Section: Pharmacologymentioning

confidence: 99%

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Shepherd¹,

Rogers²,

Anderson³

et al. 2008

Health Technol Assess

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Section: Pharmacologymentioning

confidence: 99%

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Shepherd¹,

Rogers²,

Anderson³

et al. 2008

Health Technol Assess

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“…A budesonide/formoterol inhaler has similar efficacy to formoterol alone as a reliever therapy in acute severe asthma [16]. By contrast, salmeterol has an equivalent bronchodilator effect but a slower onset of action and systemic side effects more prolonged than those of formoterol [17][18][19]. Furthermore, formoterol has a steeper bronchodilator and bronchoprotective dose-response curve than salmeterol, with a greater improvement at higher doses, which probably reflects the fact that formoterol is a full agonist, whereas salmeterol is a partial agonist [20,21].…”

Section: A Single Inhaler For Maintenance and Relief: Clinical Evidencementioning

confidence: 99%

Scientific rationale for using a single inhaler for asthma control

Barnes¹

2007

Eur Respir J

139

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Clinical trials have recently demonstrated that using a budesonide/formoterol combination inhaler as regular maintenance treatment twice daily but also as a rescue therapy for breakthrough symptoms can provide more effective control of asthma, particularly in reducing exacerbations, than using a short-acting b 2 -agonist or formoterol as rescue therapy. This suggests that the corticosteroid component of the combination therapy plays an important role in rescue therapy.Formoterol as a rescue therapy is effective in relieving symptoms by relaxing airway smooth muscle but is also likely to have important inhibitory effects on mast cells, plasma exudation and neutrophilic inflammation.Inhaled corticosteroids have much more rapid suppressing effects on airway inflammation than previously recognised and the increased dose used as rescue therapy may prevent the increase in airway inflammation that occurs during the evolution of an exacerbation, thus preventing its development.It is likely that the molecular interactions between b 2 -agonists and corticosteroids also enhance the effect of the combination therapy as rescue therapy. There is now a strong scientific rationale for single inhaler therapy in asthma, but more research is now needed to better understand the mechanisms involved.

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“…There is therefore a powerful scientific rationale for combining b 2 -agonists and corticosteroids in a single inhaler (LABACS), as most patients with asthma will need both treatments. LABACS inhalers with salmeterol/ fluticasone (Seretide/Advair/Viani) and budesonide/ formoterol (Symbicort) are now widely available and have proved to be remarkably effective in clinical trials [4,5,[86][87][88][89][90][91][92]. LABACS inhalers provide better overall control of asthma and are the new "gold standard" of therapy [93].…”

Section: Clinical Benefitmentioning

confidence: 99%

Scientific rationale for inhaled combination therapy with long-acting β₂-agonists and corticosteroids

Barnes¹

2002

Eur Respir J

428

243

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Scientific rationale for inhaled combination therapy with long-acting b 2 -agonists and corticosteroids. P.J. Barnes. #ERS Journals Ltd 2002. ABSTRACT: The addition of an inhaled long-acting b 2 -agonist (LABA) to an inhaled corticosteroid (ICS) gives optimal control of asthma in most patients and two fixed combination inhalers (salmeterol/fluticasone and formoterol/budesonide) are increasingly used as a convenient controller in patients with persistent asthma. There is a strong scientific rationale for the combination of these two drug classes.ICS suppress the chronic inflammation of asthma and reduce airway hyperresponsiveness and this is achieved at low doses in most patients. LABA act on different aspects of the pathophysiology of asthma. In addition to their bronchodilator action, LABA also inhibit mast cell mediator release, plasma exudation and may reduce sensory nerve activation. Thus these two classes of drug address complementary aspects of the pathophysiology of asthma that neither drug class is able to achieve alone.There are several positive interactions between LABA and ICS. Corticosteroids increase the expression of b 2 -receptors by increasing gene transcription. Experimentally this protects against the loss of b 2 -receptors in response to long-term exposure to b 2 -agonists. While this is unlikely to be important in bronchodilator responses to b 2 -agonists, in view of the large b-receptor reserve, it is probably important in preventing loss of b-agonist effects on the nonbronchodilator actions of LABA discussed earlier. b 2 -Agonists may potentiate the molecular mechanism of corticosteroid actions, with increased nuclear localization of glucocorticoid receptors and additive or sometimes synergistic suppression of inflammatory mediator release. Thus LABA and ICS may optimize each others beneficial actions in the airways, but the low systemic effects of these drugs do not result in any increase in adverse effects.Long-acting b 2 -agonists corticosteroid inhaler therapy is therefore a logical advance and results in effective control of asthma in the majority of patients without significant adverse effects. This simplified approach to long-term asthma therapy has a strong scientific rationale.

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Onset of Bronchodilation of Budesonide/Formoterol vs. Salmeterol/Fluticasone in Single Inhalers

Cited by 102 publications

References 17 publications

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Scientific rationale for using a single inhaler for asthma control

Scientific rationale for inhaled combination therapy with long-acting β₂-agonists and corticosteroids

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Onset of Bronchodilation of Budesonide/Formoterol vs. Salmeterol/Fluticasone in Single Inhalers

Cited by 102 publications

References 17 publications

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over

Scientific rationale for using a single inhaler for asthma control

Scientific rationale for inhaled combination therapy with long-acting β2-agonists and corticosteroids

Contact Info

Product

Resources

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Scientific rationale for inhaled combination therapy with long-acting β₂-agonists and corticosteroids