Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment
Abstract Background Asthma management may involve a step up in treatment when symptoms are not well controlled. We examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher, fixed-dose budesonide plus as-needed terbutaline in patients requiring step-up f...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12890-017-0401-y |
| _version_ | 1818153594031964160 |
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| author | Christine R. Jenkins Göran Eriksson Eric D. Bateman Helen K. Reddel Malcolm R. Sears Magnus Lindberg Paul M. O’Byrne |
| author_facet | Christine R. Jenkins Göran Eriksson Eric D. Bateman Helen K. Reddel Malcolm R. Sears Magnus Lindberg Paul M. O’Byrne |
| author_sort | Christine R. Jenkins |
| collection | DOAJ |
| description | Abstract Background Asthma management may involve a step up in treatment when symptoms are not well controlled. We examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher, fixed-dose budesonide plus as-needed terbutaline in patients requiring step-up from Step 2 treatment (low-dose inhaled corticosteroids), stratified by baseline reliever use. Methods A post-hoc analysis utilized data from three clinical trials of 6–12 months’ duration. Patients aged ≥12 years with symptomatic asthma uncontrolled despite Step 2 treatment were included. Severe exacerbation rate, lung function and reliever use were analysed, stratified by baseline reliever use (<1, 1–2 and >2 occasions/day). Results Overall, 1239 patients were included. Reductions in severe exacerbation rate with budesonide/formoterol MRT versus fixed-dose budesonide were similar across baseline reliever use levels, and were statistically significant in patients using 1–2 (42%, p = 0.01) and >2 (39%, p = 0.02) reliever occasions/day, but not <1 reliever occasion/day (35%, p = 0.11). Both treatments significantly increased mean FEV1 from baseline; improvements were significantly greater for budesonide/formoterol MRT in all reliever use groups. Reductions in reliever use from baseline were significantly greater with budesonide/formoterol MRT versus fixed-dose budesonide in patients using 1–2 and >2 reliever occasions/day (−0.33 and −0.74 occasions/day, respectively). Conclusions Treatment benefit with budesonide/formoterol MRT versus higher, fixed-dose budesonide plus short-acting β2-agonist was found in Step 2 patients with relatively low reliever use, supporting the proposal that budesonide/formoterol MRT may be useful when asthma is uncontrolled with low-dose inhaled corticosteroid. |
| first_indexed | 2024-12-11T14:13:05Z |
| format | Article |
| id | doaj.art-e5b23d4b85d045258a82d031a544d539 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-11T14:13:05Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-e5b23d4b85d045258a82d031a544d5392022-12-22T01:03:20ZengBMCBMC Pulmonary Medicine1471-24662017-04-011711810.1186/s12890-017-0401-yEfficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatmentChristine R. Jenkins0Göran Eriksson1Eric D. Bateman2Helen K. Reddel3Malcolm R. Sears4Magnus Lindberg5Paul M. O’Byrne6Department of Thoracic Medicine, Concord Hospital and The George Institute for Global HealthDepartment of Respiratory Medicine and Allergology, University HospitalDivision of Pulmonology, Department of Medicine, University of Cape TownClinical Management Group, Woolcock Institute of Medical Research, University of SydneyMichael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster UniversityBiometrics and Information Sciences (B&I), AstraZeneca R&DMichael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster UniversityAbstract Background Asthma management may involve a step up in treatment when symptoms are not well controlled. We examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher, fixed-dose budesonide plus as-needed terbutaline in patients requiring step-up from Step 2 treatment (low-dose inhaled corticosteroids), stratified by baseline reliever use. Methods A post-hoc analysis utilized data from three clinical trials of 6–12 months’ duration. Patients aged ≥12 years with symptomatic asthma uncontrolled despite Step 2 treatment were included. Severe exacerbation rate, lung function and reliever use were analysed, stratified by baseline reliever use (<1, 1–2 and >2 occasions/day). Results Overall, 1239 patients were included. Reductions in severe exacerbation rate with budesonide/formoterol MRT versus fixed-dose budesonide were similar across baseline reliever use levels, and were statistically significant in patients using 1–2 (42%, p = 0.01) and >2 (39%, p = 0.02) reliever occasions/day, but not <1 reliever occasion/day (35%, p = 0.11). Both treatments significantly increased mean FEV1 from baseline; improvements were significantly greater for budesonide/formoterol MRT in all reliever use groups. Reductions in reliever use from baseline were significantly greater with budesonide/formoterol MRT versus fixed-dose budesonide in patients using 1–2 and >2 reliever occasions/day (−0.33 and −0.74 occasions/day, respectively). Conclusions Treatment benefit with budesonide/formoterol MRT versus higher, fixed-dose budesonide plus short-acting β2-agonist was found in Step 2 patients with relatively low reliever use, supporting the proposal that budesonide/formoterol MRT may be useful when asthma is uncontrolled with low-dose inhaled corticosteroid.http://link.springer.com/article/10.1186/s12890-017-0401-yAsthmaBronchodilatorsCorticosteroidsRespiratory therapyTherapy |
| spellingShingle | Christine R. Jenkins Göran Eriksson Eric D. Bateman Helen K. Reddel Malcolm R. Sears Magnus Lindberg Paul M. O’Byrne Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment BMC Pulmonary Medicine Asthma Bronchodilators Corticosteroids Respiratory therapy Therapy |
| title | Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment |
| title_full | Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment |
| title_fullStr | Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment |
| title_full_unstemmed | Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment |
| title_short | Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment |
| title_sort | efficacy of budesonide formoterol maintenance and reliever therapy compared with higher dose budesonide as step up from low dose inhaled corticosteroid treatment |
| topic | Asthma Bronchodilators Corticosteroids Respiratory therapy Therapy |
| url | http://link.springer.com/article/10.1186/s12890-017-0401-y |
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