Inhaled budesonide/formoterol combination used as required may be beneficial for asthma patients
Steroids prn reduce asthma attacks |
Maintenance plus as required budesonide in combination with formoterol reduces the risk of severe exacerbations of asthma, according to new data published in The
Lancet this week (2006;368:744).
Researchers conducted a 12-month randomised parallel-group study of 3,394
patients who had symptoms of asthma despite regular use of a budesonide-formoterol
combination (Symbicort turbohaler 160/4.5µg twice daily) during
a two-week run-in period. The aim was to compare the add-on efficacy
of three reliever therapies: terbutaline (Bricanyl turbohaler 0.4mg),
formoterol (Oxis turbohaler 4.5µg) or budesonide-formoterol (160/4.5µg)
as required. The primary outcome was time to first severe exacerbation.
The researchers found that the time to first severe exacerbation was
longer in the as needed budesonide-formoterol group than in the formoterol
group (P=0.0048) or the terbutaline group (P<0.0001). The rate of
severe exacerbations was 37, 29 and 19 per 100 patients per year in the
terbutaline, formoterol and budesonide-formoterol groups, respectively.
The researchers note that the average additional dose of budesonide was
only 163µg per day. All treatments were well tolerated, they say.
“Our study shows that the budesonide component of the budesonide-formoterol
combination used when needed has a beneficial role in patients who remain
symptomatic despite treatment with combination maintenance therapy,” say
the authors. They suggest that inhaled corticosteroids taken as needed
might supplement the tissue concentrations of maintenance inhaled corticosteroids,
which can be less than 10 per cent of peak values after six hours. However,
they add that before the approach can be widely adopted, it should be
determined whether it is both more effective and cost-effective than
a higher maintenance dose of inhaled corticosteroids and long-acting
beta2-agonists together with short-acting beta2-agonists.
Anna Murphy, consultant respiratory pharmacist at Glenfield Hospital,
Leicester, commented: “When patients identify the signs of a forthcoming
exacerbation there is a need for an adjustable dosing regimen that permits
a temporary increase in their medication to control the symptoms. This
study provides further evidence to support the adjustable approach of
fluctuating the inhaled corticosteroid dose (as a combination with a
long-acting beta2-agonist) according to the patient’s symptoms.” She
adds that since compliance among patients is negatively affected by the
complexity of the regimen it may be improved by the approach used in
this study.
Symbicort Maintenance and Reliever Therapy is being reviewed by the European
Medicines Agency and is not licensed for use in the UK. |
The
Pharmaceutical Journal
Acrobat
Reader