Formoterol (OXIS®) Turbuhaler® as a rescue therapy compared with salbutamol pMDI plus spacer in patients with acute severe asthma

Abstract

Formoterol has a similar onset of effect to salbutamol but a prolonged duration of action. However, the relative efficacy of the two drugs in acute severe asthma is not known. This double-blind, double-dummy study compared the safety and efficacy of the maximum recommended daily dose of formoterol and a predicted equivalent dose of salbutamol in 88 patients presenting to the emergency department with acute severe asthma. Patients were randomized to formoterol 54 microg via Turbuhaler or salbutamol 2400 microg via pressurized metered dose inhaler (pMDI) plus spacer in three equal doses over 1 h. Following the full dose, mean FEV1 at 75 min increased by 37% for formoterol and 28% for salbutamol (P = 0.18). The maximum increase in FEV1 over 4 h was significantly greater with formoterol compared with salbutamol (51% vs. 36%, respectively P < 0.05) and formoterol was as effective as salbutamol at improving symptoms and wellbeing. Both treatments were well tolerated. Formoterol caused a greater decrease in serum potassium (difference -0.2 mmol/l). In severe acute asthma, bronchodilator therapy with high-dose (54 microg) formoterol Turbuhaler provided equally rapid improvements in lung function of greater magnitude over 4 h than high-dose (2400 microg) salbutamol pMDI plus spacer.

Global strategy for asthma management and prevention: GINA executive summary

“…Because of the additive effect of this combination, the low dose of glucocorticosteroid is usually sufficient and need only be increased if control is not achieved within 3-4 months with this regimen (Evidence A). The long-acting b 2 -agonist formoterol, which has a rapid onset of action whether given alone [285][286][287][288] or in combination inhaler with budesonide [289,290], has been shown to be as effective as short-acting b 2 -agonist in acute asthma exacerbation. However, its use as monotherapy as a reliever medication is strongly discouraged, since it must always be used in association with an inhaled glucocorticosteroid.…”

“…Rapid-acting inhaled b 2 -agonists should be administered at regular intervals (Evidence A) [337][338][339]. Although most rapid-acting b 2 -agonists have a short duration of effect, the long-acting bronchodilator formoterol, which has both a rapid onset of action and a long duration of effect, has been shown to be equally effective without increasing side-effects, though it is considerably more expensive [285]. Studies of intermittent versus continuous nebulised short-acting b 2 -agonists in acute asthma provide conflicting…”

A Pharmacological Comparative Study of Arformoterol and Salbutamol Nebulization in the Management of Patients Suffering From Acute Non-Severe Bronchial Asthma

“…Several studies have shown the efficacy of formoterol in acute non-severe asthma, acute severe asthma, exercise induced bronchospasm, childhood asthma, and COPD. [15][16][17][18][19] Although few studies have shown clinically significant improvement in lung function (FEV1) with formoterol when compared with salbutamol, 16 most studies have shown a comparable efficacy. 15,17 Safety of formoterol is also well documented even at high doses in patients with asthma and COPD.…”

“…In few studies, the impact of high-dose formoterol on heart rate, blood pressure, serum potassium, electrocardiogram changes, and arterial blood gas were assessed which showed identical changes comparable with salbutamol. 16,20 However, in our study we only evaluated the adverse effects reported by the patients.…”

Pharmacological strategies for self-management of asthma exacerbations

“…A double-blind, double-dummy study by BOONSAWAT et al [37] examined the acute efficacy of 54 mg formoterol by Turbuhaler1 (AstraZeneca Liquid production) compared with 2,400 mg salbutamol by metered-dose inhaler and spacer, each given in three divided doses over 1 h, in 88 patients presenting to the ED with acute asthma. This study showed similar bronchodilatation at 75 min (37% versus 28%, p50.18) and greater bronchodilatation at 4 h (51% versus 36%, p,0.05) with formoterol compared with salbutamol.…”