Flexible dosing of combination inhaler cuts asthma exacerbations
Allowing asthma patients to use flexible dosing of the combined budesonide/formoterol (Symbicort) inhaler reduces the rate of severe exacerbations by 40 per cent compared to fixed-dose treatment, according to a study reported at a recent European respiratory meeting in Vienna.
The study involved 658 patients with moderate asthma who remained symptomatic
despite regular treatment with inhaled steroids and, in most cases, a
long-acting bronchodilator.
Patients were randomly allocated to six months’ treatment with
one of three regimens: flexible dosing of budesonide/formoterol (160/4.5mg,
one to two inhalations twice a day, with the possibility of a temporary
increase up to four inhalations twice a day for a maximum
of two weeks when symptoms worsened), fixed dose budesonide/formoterol
(160/4.5mg, two inhalations twice a day) or salmeterol/fluticasone (Seretide,
50/250mg, one inhalation twice a day).
Results demonstrated that all three regimens achieved similar levels
of asthma control. However, patients receiving flexible dosing had 40
per cent fewer severe exacerbations than those in either of the fixed
dosing groups. Patients in the adjustable dosing arm used 27 per cent
less short-acting bronchodilator for symptom relief.
Dr John Haughney, a Glasgow general practitioner and a member of the
primary care respiratory diseases group, said: “Allowing patients
to step up their medication dose at the first sign of asthma worsening
can prevent escalation into an exacerbation.” He added: “Once
their asthma is under control, patients can step down their dose again.” |
