Rescue Use of Beclomethasone and Albuterol in a Single Inhaler for Mild Asthma

Papi, Alberto; Canonica, Giorgio Walter; Maestrelli, Piero; Paggiaro, Pierluigi; Olivieri, Dario; Pozzi, Ernesto; Crimi, Nunzio; Vignola, Antonio M.; Morelli, Paolo; Nicolini, Gabriele; Fabbri, Leonardo M.

doi:10.1056/nejmoa063861

Cited by 318 publications

(309 citation statements)

References 34 publications

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“…The issue of improving compliance with once-daily administration of the ICSs remains to be evaluated in controlled clinical trials. In patients with mild or intermittent asthma, the use of ICSs as needed with rescue bronchodilator or intermittently at high doses for a prescribed duration (5-10 d) has been investigated in pediatric and adult populations (30)(31)(32)(33)(34)(35). These studies have been inconsistent and confirm greater efficacy of daily use of ICSs for controlling the impairment domain and mixed effects on preventing exacerbations requiring oral corticosteroids (30)(31)(32)(33)(34)(35).…”

Section: Dosing Strategiesmentioning

confidence: 99%

“…In patients with mild or intermittent asthma, the use of ICSs as needed with rescue bronchodilator or intermittently at high doses for a prescribed duration (5-10 d) has been investigated in pediatric and adult populations (30)(31)(32)(33)(34)(35). These studies have been inconsistent and confirm greater efficacy of daily use of ICSs for controlling the impairment domain and mixed effects on preventing exacerbations requiring oral corticosteroids (30)(31)(32)(33)(34)(35). Although the combination BUD with the long-acting b 2 agonist (LABA) formoterol in a single inhaler has been approved in Europe and other countries for maintenance and reliever therapy, it has not been approved for this use in the United States, and recently concerns have been expressed that patients receiving this therapy are not well controlled and may have inadequately treated airways inflammation (30).…”

Section: Dosing Strategiesmentioning

confidence: 99%

See 1 more Smart Citation

Inhaled Corticosteroids in Lung Diseases

Raissy¹,

Kelly²,

Harkins

et al. 2013

Am J Respir Crit Care Med

109

101

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Section: Dosing Strategiesmentioning

confidence: 99%

Section: Dosing Strategiesmentioning

confidence: 99%

Inhaled Corticosteroids in Lung Diseases

Raissy¹,

Kelly²,

Harkins

et al. 2013

Am J Respir Crit Care Med

109

101

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“…However, LTRA do not provide as good a benefit as low-dose inhaled CS therapy [115,116] although they remain an alternative therapy, particularly in pediatric patients. One study indicated that the intermittent use of ICS combined with a short-acting β-agonist (SABA) as needed was as effective as the regular use of ICS twice daily with SABA as needed [117]. This is an interesting concept that could be considered further.…”

Section: Mild Persistent Asthmamentioning

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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“…In addition, many of the secondary outcomes evaluating lung function and symptom control were also most consistently the best in the group receiving combination therapy as both maintenance and reliever medication. Interestingly, one investigative group has demonstrated that the benefit of combination therapy can be attributable to both the ICS and LABA components (34); another group has demonstrated that in more mild persistent asthma, significant clinical benefit can be observed with the concomitant use of ICS 1 SABA (albuterol) used only on an as-needed basis (35). Taken together, these findings indicate that the periodic use of ICS along with some form of b-agonist as relief medication has the potential for reducing exacerbation risk in both mild and moderate persistent asthma.…”

Section: Combination Therapymentioning

confidence: 99%

Asthma Therapies Revisited: What Have We Learned?

Lemanske

2009

Proceedings of the American Thoracic Society

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Asthma is a heterogenous disorder related to numerous biologic, immunologic, and physiologic components that generate multiple clinical phenotypes. Further, genetic and environmental factors interact in ways that produce variability in both disease onset and severity and differential expression based on both the age and sex of the patient. Thus, the natural history of asthma is complex in terms of disease expression, remission, relapse, and progression. As such, therapy for asthma is complicated and has been approached from the standpoints of primary, secondary, and tertiary prevention. Presently, asthma cannot be cured but can be controlled in most patients, an indication that most of the success clinical research strategies have realized has been in the area of tertiary prevention. Since for many adult patients with asthma their disease had its roots in early life, much recent research has focused on events during early childhood that can be linked to subsequent asthma development with the hopes of creating appropriate interventions to alter its natural history of expression. These research approaches can be categorized into three questions. Who is the right patient to treat? When is the right time to begin treatment? And finally, what is the appropriate treatment to prescribe?

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Rescue Use of Beclomethasone and Albuterol in a Single Inhaler for Mild Asthma

Cited by 318 publications

References 34 publications

Inhaled Corticosteroids in Lung Diseases

Inhaled Corticosteroids in Lung Diseases

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

Asthma Therapies Revisited: What Have We Learned?

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