Budesonide/formoterol in a single inhaler rapidly relieves methacholine-induced moderate-to-severe bronchoconstriction

Woude, H. J. van der; Boorsma, Martin; Bergqvist, Peter B. F.; Winter, Trea H; Aalbers, Rick

doi:10.1016/j.pupt.2003.11.001

Cited by 56 publications

(36 citation statements)

References 18 publications

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“…Formoterol as a reliever gives rapid and sustained relief of symptoms during an exacerbation [31]. As expected, budesonide/formoterol also gives rapid bronchodilatation, which mirrors the action of formoterol on methacholine-induced bronchoconstriction [18] and equivalent bronchodilator effects to a high dose of salbutamol in treating acute severe asthma [15]. The bronchodilator response to formoterol shows a small reduction during initiation of treatment due to the rapid development of tolerance but this does not progress [32].…”

Section: Formoterol For Acute Exacerbationsmentioning

confidence: 68%

“…A budesonide/formoterol inhaler has similar efficacy to formoterol alone as a reliever therapy in acute severe asthma [16]. By contrast, salmeterol has an equivalent bronchodilator effect but a slower onset of action and systemic side effects more prolonged than those of formoterol [17][18][19]. Furthermore, formoterol has a steeper bronchodilator and bronchoprotective dose-response curve than salmeterol, with a greater improvement at higher doses, which probably reflects the fact that formoterol is a full agonist, whereas salmeterol is a partial agonist [20,21].…”

Section: A Single Inhaler For Maintenance and Relief: Clinical Evidencementioning

confidence: 99%

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Scientific rationale for using a single inhaler for asthma control

Barnes¹

2007

European Respiratory Journal

138

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Clinical trials have recently demonstrated that using a budesonide/formoterol combination inhaler as regular maintenance treatment twice daily but also as a rescue therapy for breakthrough symptoms can provide more effective control of asthma, particularly in reducing exacerbations, than using a short-acting b 2 -agonist or formoterol as rescue therapy. This suggests that the corticosteroid component of the combination therapy plays an important role in rescue therapy.Formoterol as a rescue therapy is effective in relieving symptoms by relaxing airway smooth muscle but is also likely to have important inhibitory effects on mast cells, plasma exudation and neutrophilic inflammation.Inhaled corticosteroids have much more rapid suppressing effects on airway inflammation than previously recognised and the increased dose used as rescue therapy may prevent the increase in airway inflammation that occurs during the evolution of an exacerbation, thus preventing its development.It is likely that the molecular interactions between b 2 -agonists and corticosteroids also enhance the effect of the combination therapy as rescue therapy. There is now a strong scientific rationale for single inhaler therapy in asthma, but more research is now needed to better understand the mechanisms involved.

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Section: Formoterol For Acute Exacerbationsmentioning

confidence: 68%

Section: A Single Inhaler For Maintenance and Relief: Clinical Evidencementioning

confidence: 99%

Scientific rationale for using a single inhaler for asthma control

Barnes¹

2007

European Respiratory Journal

138

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“…Patients take additional inhalations immediately during periods of suboptimal control for relief and to improve control, while relying only on the maintenance dose of budesonide/formoterol when symptom free. This novel management strategy, which is possible with budesonide/ formoterol owing to its rapid onset of action [8,9] and dose-response profile [10,11], is closely in line with normal patient behaviour, as patients tend to take more as-needed medication as their asthma control declines [12]. A recent 1-yr double-blind study involving .2,500 patients with persistent asthma compared budesonide/formoterol for maintenance plus as needed with an equivalent maintenance dose of budesonide/formoterol plus SABA as needed [13].…”

mentioning

confidence: 99%

Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

Vogelmeier

D’Urzo²,

Pauwels³

et al. 2005

European Respiratory Journal

190

176

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This 12-month dose-titration study assessed the effectiveness of budesonide/ formoterol for maintenance plus relief with a control group using salmeterol/fluticasone for maintenance plus salbutamol for relief.Adolescents and adults (n52,143; mean forced expiratory volume in one second (FEV1) 73% predicted; mean inhaled corticosteroid (ICS) 884 mg?day ). The simplified strategy using budesonide/formoterol for maintenance and reliever therapy is feasible, safe and at least as effective as salmeterol/fluticasone plus salbutamol.

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“…As a result these patients end up being treated at step 3 of the BTS Asthma Guidelines. 4 Efficacy studies of antiasthma therapies have traditionally used measures of airways function, such as spirometry [forced expiratory volume in 1 second (FEV 1 )] 7,8 and domiciliary peak expiratory flow (PEF), 7 or measures of airway hyper-reactivity, such as methacholine bronchial challenge testing, [9][10][11][12] to demonstrate therapeutic effectiveness. While these measures provide objective information on airway function, they provide no information on patient perceived effectiveness of an asthma treatment or asthma control.…”

Section: Scientific Backgroundmentioning

confidence: 99%

A pragmatic single-blind randomised controlled trial and economic evaluation of the use of leukotriene receptor antagonists in primary care at steps 2 and 3 of the national asthma guidelines (ELEVATE study).

Price

Musgrave²,

Wilson³

et al. 2011

Health Technol Assess

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Budesonide/formoterol in a single inhaler rapidly relieves methacholine-induced moderate-to-severe bronchoconstriction

Cited by 56 publications

References 18 publications

Scientific rationale for using a single inhaler for asthma control

Scientific rationale for using a single inhaler for asthma control

Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?

A pragmatic single-blind randomised controlled trial and economic evaluation of the use of leukotriene receptor antagonists in primary care at steps 2 and 3 of the national asthma guidelines (ELEVATE study).

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