Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children

Abstract

Single inhaler therapy has now been demonstrated to reduce exacerbations requiring oral corticosteroids against current best practice strategies and against a fixed higher dose of inhaled steroids. The strength of evidence that SiT reduces hospitalisation against these same treatments is weak. There were more discontinuations due to adverse events on SiT compared to current best practice, but no significant differences in serious adverse events. Our confidence in these conclusions is limited by the open-label design of the trials, and by the unknown adherence to treatment in the current best practice arms of the trials.Single inhaler therapy can reduce the risk of asthma exacerbations needing oral corticosteroids in comparison with fixed dose maintenance ICS and separate relief medication. The reduced odds of exacerbations with SiT compared with higher dose ICS should be viewed in the context of the possible impact of LABA withdrawal during study run-in. This may have made the study populations more likely to respond to SiT.Single inhaler therapy is not currently licensed for children under 18 years of age in the United Kingdom and there is currently very little research evidence for this approach in children or adolescents.

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…Adding LABA to the same dose of ICS provides additional improvements in symptoms and lung function with a reduced risk of exacerbations 166 (Evidence A). In at-risk patients, the ICS/formoterol maintenance and reliever regimen significantly reduces exacerbations and provides similar levels of asthma control at relatively low doses of ICS, compared with a fixed dose of ICS/LABA as maintenance treatment or a higher dose of ICS, both with asneeded SABA [167][168][169][170][171] (Evidence A).…”

“…The combination of rapid-onset LABA (formoterol) and low dose ICS (budesonide or beclometasone) in a single inhaler as both the controller and the reliever medication is effective in improving asthma control, 140 and in at-risk patients, reduces exacerbations requiring OCS, and hospitalizations [167][168][169][170] (Evidence A). The combination ICS/formoterol inhaler may be taken up to a maximum total formoterol dose of 72 mcg in a day (Evidence A).…”

Guía Mexicana del Asma: GUIMA 2017

“…19,36,37,38,39 Por ello, en adolescentes o adultos con asma y tratamiento de Paso 3, 4 o 5 de mantenimiento con CEI (BUD o beclometasona) + formoterol, sugerimos la estrategia SMART usando el mismo CEI + formoterol de mantenimiento y rescate el momento que se pierde el control (exacerbaciones leves). La anterior no es una opción de manejo para crisis.…”

“…Camargo-Angeles, 35 Rogelio García-Torrentera, 20 Saraí Toral-Freyre, 20 Gabriel Montes-Narváez, 25 Héctor Solorio-Gómez, 36 Juan Rosas-Peña, 37 Sergio Jesús Romero-Tapia, 38 Adela Reyes-Herrera, 39 Francisco Cuevas-Schacht, 40 Joaquín Esquer-Flores, 41 José Antonio Sacre-Hazouri, …”

Modern Strategies for the Therapy of Persistent Bronchial Asthma in Adolescents

“…К сожалению, исследований, в которые были включены подростки, немного. Так, в 2013 г. в Cochrane Database of Systematic Reviews был опубликован обзор о ранее проведенных исследованиях с использованием SMART-терапии у под-ростков [24]. В обзор были включены 13 исследований, в которых приняли участие 224 ребенка и 13 152 под-ростка и взрослых.…”