The Pharmaceutical Journal
Vol 277 No 7418 p334
16 September 2006

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Letters to the Editor

Asthma

More research on combination therapy is needed

From Mr C. A. Deeney, MRPharmS

Your news item “Inhaled budesonide/formoterol combination used as required may be beneficial for asthma patients” (PJ, 26 August, p242) discusses adding three possible “as required” therapies to regimens for patients already using a budesonide-formoterol combination. It notes that a study found that in a 12-month period the rate of severe asthma exacerbations was 37, 29 and 19 per 100 patients per year in terbutaline as required, formoterol as required and budesonide-formoterol as required groups, respectively. Although this appears to support the latter regimen when compared with the other two, why was there not a fourth group studied, where they used budesonide alone as required as add-on therapy?

Indeed, your heading and the comments by consultant respiratory nurse Anna Murphy suggest that the combination of corticosteroid with a long-acting beta₂-agonist is favourable. However, it would appear that, at first glance of these few figures, budesonide alone might be the reason. The researchers, in the excerpt quoted in The Pharmaceutical Journal state: “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.” I agree with this statement and cannot see how it necessarily supports combination therapy. Rather, it seems to me, more research is needed.

Colin Deeney
Donegal, Ireland

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