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June 2007 QUIZ OF THE MONTH . . .
There has been considerable interest in the use of inhaled long-acting beta agonists (LABA) such as salmeterol (Sal) or formoterol (Form) in the treatment of persistent asthma (PA). Which of the statements below about LABA are true or false?
- Addition of LABA therapy to maintenance treatment of PA with an inhaled corticosteroid (ICS) will allow at least a 50% reduction in the ICS dose required for asthma control.
- Maintenance LABA monotherapy is an appropriate first line therapy of PA.
- Increasing the dosage of maintenance formoterol-budesonide combination treatment is not as effective as adding inhaled albuterol to such maintenance formoterol-budesonide treatment in the initial treatment of an acute asthma exacerbation.
- There is a faster onset of the bronchodilating activity of Form than of Sal.
- Addition of therapy with montelukast, a leukotriene receptor antagonist, is more effective than added LABA in allowing asthma control at a lower maintenance ICS dosage.
Discussion
The addition of either Sal or Form to maintenance ICS therapy of PA will allow asthma control at ICS doses of 50% or less than the ICS dosage required when the ICS is used as monotherapy. The addition of montelukast to ICS therapy is generally less effective than added LABA in allowing asthma control at lower ICS doses. LABA used as monotherapy may relieve much of the asthma symptoms. However, based on findings in the SMART study, the FDA has required a "black box" warning that chronic use of Sal as monotherapy may be associated with a higher frequency of fatal/near fatal asthma episodes.Thus, chronic Sal treatment should not be first line treatment of PA.
Several recent studies have shown that increasing the dosage of maintenance formoterol-budesonide combination therapy is more effective than adding inhaled albuterol in arresting a developing acute asthma exacerbation. This beneficial effect may be due in part to the rapid onset of bronchodilating effect of Form (as fast as albuterol and significantly faster than the onset of Sal bronchodilating effect).
References
1. Drugs 2003;63:Suppl 2:21-33
2. Respiration 2004;71:594-601
3. Pediatr Allergy Immunol 2004;15:32-9
4. J Allergy Clin Immunol 2007; April 20, E pub
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