SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

11/16/05

Budesonide/formoterol combination as maintenance and reliever therapy

Summary
Background - Inhalers containing combinations of an inhaled corticosteroid (ICS) and long acting beta agonist (LABA) such as budesonide/formoterol (Bud/Form) or Fluticasone/salmeterol (Flut/Sal) have to be shown to be very effective maintenance therapy for most patients with persistent asthma. Because of its rapid onset of action, Form can also be effective as a reliever (rescue) treatment of acute asthma exacerbations (AAE).

Findings - Vogelmeier et al of Philipps - Univ Manburg in Germany compared the effectiveness of: 1) a combination of Bud/Form (160/4.5 mcg b.i.d.) for both maintenance and reliever use vs 2) a combination of Flut/Sal (250/50 mcg b.i.d) with albuterol reliever use for any increased symptoms.

After 4 weeks treatment, there was a decreased frequency of AAE and prolongation of time to the first AAE in those treated with adjusted doses of Bud/Form than in those treated with Flut/Sal plus albuterol prn. There was also less as needed reliever usage in those treated with Bud/Form. The mean ICS use during the 4 week period was not significantly different in the 2 treatment groups.

Reference
Eur Respir J 2005;26:819-28

Editor's Comments
The authors of this report concluded that the use of Bud/Form combination for both maintenance and reliever therapy is feasible, safe and at least as effective as Flut/Sal treatment with albuterol used as reliever therapy. One can argue that the improved outcomes with Bud/Form treatment reflects the greater efficacy of such compounds compared to Flut/Sal. However, a recent study found Bud/Form used in adjusted doses was more effective than Bud alone with as needed use of albuterol..

 

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