SELECTED ARTICLES FROM THE RECENT LITERATURE 2006 2/21/06 Budesonide/formoterol combination inhaler for maintenance and relief in moderate asthma Summary Background – A combination inhaler containing budesonide (an ICS) and formoterol, a long acting beta agonist, (Bud/Form) is now used extensively as maintenance therapy for persistent asthma (PA). However, less is known about the use of Bud/Form inhalers for relief of acute worsening asthma. Findings – Rabe et al of the Leiden Univ Med Center in the Netherlands carried out a randomized, double blind comparison of a Bud/Form combination inhaler (dose-160/9 microg daily), increasing the dose for worsening asthma, vs increased doses of Bud plus prn inhaler terbutaline for relief in 697 adults with mild-moderate PA for 6 months. Treatment with the Bud/Form inhaler regimen led to a greater increase in peak flow (p=0.001), and fewer severe exacerbations (p=0.001) than treatment with increased doses of Bud (320 microg/day) plus prn terbutaline (0.4 mg). There was also 90% fewer asthma hospitalizations in those treated with the Bud/Form inhaler. These superior effects of the Bud/Form inhaler were achieved with an average lower daily dose of Bud (240 microg/day) and less need for oral steroids than occurred with the increased Bud plus prn terbutaline regimen. Reference Chest 2006;129:246-56 Editor's Comments These impressive findings provide additional evidence that a combination Bud/Form inhaler can be used for both maintenance and relief of acute worsening of PA. A recent study found that Bud/Form combination therapy was more effective than higher doses of Bud plus prn use of Form. Whether adverse effects occurs with chronic use of Form remains to be determined. However, the FDA has required a “Black Box” warning about the chronic use of long-acting beta agonists in view of the findings in the SMART study. © Copyright 1997-2006 American Academy of Allergy, Asthma and Immunology All rights reserved