Budesonide plus formoterol for reliever therapy in asthma.

摘要

The recommended treatment for asthma is maintenance therapy with inhaled corticosteroids or combination therapy with an inhaled corticosteroid and a long-acting (32 agonist.Furthermore, treatment with a rapid-acting (32 agonist is used as rescue therapy.When the asthma is not controlled, the level of maintenance therapy should be increased. This strategy has recently been challenged by studies that suggest the use of an inhaled corticosteroid and a long-acting beta2 agonist in one inhaler for both maintenance and as-needed therapy.Because this option necessarily increases the use of two different drugs, the question has been raised as to their relative contribution to the additional clinical effects. In today's Lancet, Klaus Rabe and colleagues4 report the findings of a study designed to address that question by comparing the effects of as-needed treatment with terbutaline, formoterol, and the combination of formoterol and budesonide in one inhaler on daily asthma control and the occurrence of asthma exacerbations in patients whose asthma is not controlled on treatment with a formoterol/budesonide 4-5/160 mug combination twice daily.The conclusions were clear for one of the components: as-needed formoterol alone had no significant effect on daily asthma control, mild exacerbations, or admissions to hospital and emergency-room visits. So, simply changing from a short-acting beta2 agonist to formoterol for as-needed use in patients with uncontrolled asthma is not a good option.