Comparison of a β<sub>2</sub>-Agonist, Terbutaline, with an Inhaled Corticosteroid, Budesonide, in Newly Detected Asthma

Haahtela, Tari; Järvinen, Markku; Kava, T; Kiviranta, K.; Koskinen, Sirkka; Lehtonen, Kaarina; Nikander, Kurt; Persson, Tore; Reinikainen, Kaija; Selroos, Olof; Sovijärvi, A.; Stenius-Aarniala, B; Svahn, Thore; Tammivaara, R; Laitinen, Lauri A.

doi:10.1056/nejm199108083250603

Cited by 758 publications

(367 citation statements)

References 13 publications

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“…Control of asthma may be obtained in most asthmatics with inhaled glucocorticoids [110,111] with improvement in asthma symptoms, in lung function and in a reduction in exacerbations of disease. This applies throughout the severity spectrum of asthma.…”

Section: Effects Of Corticosteroids On Asthma Controlmentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

121

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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Section: Effects Of Corticosteroids On Asthma Controlmentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

121

106

View full text Add to dashboard Cite

show abstract

“…21,22 This recommendation was prompted by studies reporting that such treatment improves PEF, FEV 1 , severity of symptoms, exacerbation frequency, and quality of life, [23][24][25] which was reinforced by reports that ICS therapy may prevent progressive loss of lung function. [26][27][28] These latter findings, noted in studies conducted in both adults and children, strongly influenced guideline recommendations for early recognition and continuous treatment of patients with mild persistent asthma.…”

Section: The Improving Asthma Control Trial (Impact)mentioning

confidence: 99%

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

Denlinger¹,

Sorkness²,

Chinchilli

et al. 2007

Journal of Allergy and Clinical Immunology

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Due to an increasing prevalence, morbidity and mortality associated with asthma, the National Heart, Lung and Blood Institute created the Asthma Clinical Research Network (ACRN) and the Childhood Asthma Research and Education (CARE) Network to improve public health. The objectives of these clinical research networks are to conduct multiple, well designed clinical trials for rapid evaluation of new and existing therapeutic approaches to asthma and to disseminate laboratory and clinical findings to the health care community. These trials comprise a large proportion of the data driving the treatment guidelines established and reviewed by the National Asthma Education and Prevention Program. This article will review the basic design and major findings of selected ACRN and CARE Network trials involving both adults and children with asthma. Collectively, these studies have helped refine the therapeutic role of existing controller medications, establish standard models for side effect evaluation and risk-benefit models, validate symptom based assessments for asthma control, and identify baseline characteristics that may predict individual patient responses. Remaining challenges include shaping the role of novel therapeutics in future guidelines, incorporating pharmacogenomic data in treatment decisions, and establishing better implementation strategies for translation to community settings, all with the goal of reducing the asthma burden on society.

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“…This inflammation leads to bronchoconstriction, which causes symptoms. Since inhaled corticosteroids (ICS) treat the inflammation of the airways, they can improve the long-term course of asthma [2][3][4][5]. For this reason ICS are the keystone in the pharmacological treatment of asthma.…”

Section: Introductionmentioning

confidence: 99%

Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program

Vries

Bemt²,

Thoonen³

et al. 2006

Primary Care Respiratory Journal

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SummaryAim: To assess whether exposure to house dust mite (HDM) allergens hampers a tapering off of inhaled corticosteroid (ICS) dosage in HDM-sensitive asthma patients. Methods: Asthma patients sensitised to HDM allergens and using ICS were selected from general practices for this observational study. Dust samples from bed mattresses were taken to assess exposure ('no', 'low', 'intermediate' or 'high') to HDM allergens with a semi-quantitative test (Acarex ® ). Patients were trained to use a self management plan to adjust the dose of ICS according to symptoms and peak flow. The observation period was three months. Results: Outcomes from 123 patients were analysed. Within the 'no' and 'low' HDM exposure groups the proportion of patients who increased the dosage of their ICS medication was significantly lower than the proportion who tapered off or remained on the same dose of ICS. The group with high exposure to HDM allergens had the highest proportion of patients who increased their dose of ICS (p = 0.055). Conclusions: High exposure to HDM allergens seems to coincide with the use of higher dose ICS treatment in asthma patients sensitised to HDM allergens.

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Comparison of a β₂-Agonist, Terbutaline, with an Inhaled Corticosteroid, Budesonide, in Newly Detected Asthma

Abstract: Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.

Cited by 758 publications

References 13 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program

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Comparison of a β2-Agonist, Terbutaline, with an Inhaled Corticosteroid, Budesonide, in Newly Detected Asthma

Abstract: Antiinflammatory therapy with inhaled budesonide is an effective first-line treatment for patients with newly detected, mild asthma, and it is superior to the use of terbutaline in such patients.

Cited by 758 publications

References 13 publications

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Guideline-defining asthma clinical trials of the National Heart, Lung, and Blood Institute's Asthma Clinical Research Network and Childhood Asthma Research and Education Network

Relationship between house dust mite (HDM) allergen exposure level and inhaled corticosteroid dosage in HDM-sensitive asthma patients on a self management program

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Comparison of a β₂-Agonist, Terbutaline, with an Inhaled Corticosteroid, Budesonide, in Newly Detected Asthma