The Pharmaceutical Journal
Vol 274 No 7333 p75
22 January 2005

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Related websites
Asthma links (more)

Possible new approach to asthma management

A novel approach to asthma management could be on the horizon: the use of formoterol/budesonide combination inhalers as both preventer and reliever therapy.

In a double-blind, randomised parallel group study, 2,760 participants were randomised to one of three treatment plans for 12 months (see Panel below). Use of a formoterol/budesonide combination inhaler as both preventer and reliever was found almost to halve the risk of a severe exacerbation compared with the other two treatment strategies. Time to the first severe exacerbation was also prolonged (P<0.001). The researchers claim that this approach provides “additional anti-inflammatory therapy and rapid symptom relief”.

According to Anna Murphy, consultant respiratory pharmacist, Glenfield Hospital, Leicester, the results are exciting. The use of a combination inhaler also has benefits in terms of concordance and costs to patients who pay prescription charges. However, Ms Murphy expressed some concerns, not least because of the contrast with recommendations from the British Thoracic Society and the Scottish Intercollegiate Guidelines Network that have been published for the past 20 years. “The education and training required to introduce a new approach to both patients and health care professionals would be immense. We know that the current guidelines are not adhered to as they should [be],” she said.

In addition, it is important to point out that it is the properties of formoterol that allow this approach to be developed, partly because it has a quick onset of action comparable to salbutamol. Combination inhalers containing salmeterol could not be used in the same way (salmeterol takes 30 minutes to have an effect) and education on this difference would be essential.

Ms Murphy was also concerned about the use of a corticosteroid on a “when required” basis. She said that it was important to ensure patients do not overdose on the inhaler.

The study is published in the American Journal of Respiratory and Critical Care (2005;171:129).