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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
12/1/06
Budesonide/formoterol - pMDI vs DPI
Summary
Background - A dry powder inhalation (DPI) combination of the inhaled corticosteroid budesonide and long-acting beta agonist formoterol (Bud/Form) is used extensively in the treatment of persistent asthma (PA). A Bud/Form combination delivered in an HFA-propelled pressurized metered dose inhaler (pMDI) has been developed. What is the comparable efficacy and safety of Bud/Form delivered by the pMDI vs delivery by DPI?
Findings - Morse et al of the Univ of Hull/Castle Hill Hospital in England carried out a multinational 52 week, randomized, open, parallel group comparison of Bud/Form (160/4.5 mcg b.i.d.) delivered by pMDI (n=446) or DPI (n=227) in adults with moderate PA.
They found no significant differences in the clinical efficacy of the two preparations as determined by improvement in lung function and time to the first severe acute asthma exacerbation. The incidence of adverse effects was also similar with both delivery systems with only1-3% of patients discontinuing therapy because of adverse effects.
Reference
Pulm Pharmacol Ther 2006, Oct 18, E pub
Editor's Comments
The findings that the clinical efficacy of Bud/Form was similar whether delivered by pMDI or DPI was somewhat surprising to me. Previous studies suggested that delivery of inhaled medications with an HFA propellant allowed deeper penetration into the lower airways than seen with use of DPI inhalers. Perhaps, the HFA propellant used in this study did not have such an effect.
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