SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

8/25/03

Use of a combination budesonide-formoterol inhaler in the treatment of moderate persistent asthma

Summary
The use of Advair, a metered dose inhaler (MDI) incorporating a combination of fluticasone, a potent inhaled corticosteroid (ICS) and salmeterol, a long-acting beta agonist (LABA) has increased greatly since its release in the USA in recent years. Budesonide (Bud) another potent ICS and formoterol (Form) another LABA are used extensively as single agents in asthma treatment. Buhl et al of the University Hospital in Mainz, Germany have reported a clinical trial of a combination MDI containing Bud 160 microg and Form 4.5 microg used once daily or twice daily in 523 individuals with moderate persistent asthma. Comparisons were made with treatment consisting of Bud 400 microg used alone once a day. After 12 weeks of such treatment, asthma control was significantly better with both once daily and twice daily Bud/Form combination treatment than with monotherapy with Bud. This improved asthma control was noted in higher mean peak flow readings in the AM and evening, less asthma symptoms, and fewer acute asthma flares. The pattern of symptoms was not significantly different with use of the Bud/Form combination once vs twice daily. The authors concluded that this combination Bud/Form treatment once daily was effective in the treatment of moderate persistent asthma.

Reference
Respir Med 2003;97:323-30

Editor’s Comments
The findings in this study are qualitatively similar to that reported earlier in studies of the combination of fluticasone and salmeterol - that is, better control of persistent asthma with less than 50% of the ICS dose needed when the same ICS was used alone. I tend to prefer Form to salmeterol because of its more rapid onset of bronchodilating action, yet duration of action at least as long as salmeterol. The once a day effectiveness of this combination is attractive, particularly in the treatment of adolescents who are resistant to the use of inhalers. However, the recent finding of a small but significant increase in mortality rates in asthmatics using a combination of fluticasone and salmeterol (in the SHARP study) raises questions that warrant further investigation of the safety of LABA.


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