A comparison of the efficacy and safety of daily inhaled budesonide/formoterol and as and when needed inhaled budesonide/formoterol combination in moderate persistent asthma
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20163244Keywords:
ACQS, Asthma free days, Exacerbations, Lung functions, Borg dyspnea score, VASAbstract
Background: To evaluate efficacy and safety of a fixed dose combination of budesonide/formoterol inhaler, when used as and when needed treatment approach in comparison with similar regimen daily.
Methods: A prospective, open label, parallel group study design, in which, screened patients, having moderate persistent asthma, underwent a 2 week of run in period, underwent randomization in two treatment groups, in one group daily treatment with fixed dose combination of budesonide/formoterol inhaler and in another group as and when needed treatment with similar medication. The assessments after baseline were done at 2, 4 and 6 weeks. The primary outcomes were Asthma Control Questionnaire Score (ACQS), asthma free days, exacerbation frequency and severity. Other outcomes were, lung functions, need for rescue medication, Modified Borg dyspnea score and patient preference on VAS.
Results: The mean age of 50 patients included in study was 40.24±2.38 years in group I, and 39.24±1.81 years in group II. Patients were followed up for 6 weeks after 2 weeks of run in period. Improvement of ACQS, exacerbation prevention and number of asthma free days were same with both the regimens. Though the drugs taken in as and when needed treatment group was almost half of daily regimen group. Adverse drug reactions (ADRs) were not found in any group. No association between adverse effects and dose was established.
Conclusions: Both the treatment regimens improve the asthma control parameters, prevent exacerbations and prevent the decline in lung functions with the similar efficacy and safety. So as and when needed treatment approach can be an alternative to daily regimen for stable moderate persistent asthma patients.
References
Haahtela T, Järvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K. Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med. 1991;325(6):388-92.
Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003;361(9363):1071-6.
O'Byrne PM, Barnes PJ, Rodriguez-Roisin R, Runnerstrom E, Sandstrom T, Svensson K. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J RespirCrit Care Med. 2001;164(8):1392-7.
Haahtela T, Järvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med. 1994;331(11):700-5.
Selroos O, Pietinalho A, Löfroos AB, Riska H. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest. 1995;108(5):1228-34.
Agertoft L, Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med. 1994;88(5):373-81.
Jindal SK, Gupta D, Aggarwal AN, Agarwal R. World Health Organization; Government of India. Guidelines for management of asthma at primary and secondary levels of health care in india (2005). Indian J Chest Dis Allied Sci. 2005;47(4):309-43.
GINA Board of directors and Science Committee members. Global strategy for asthma management and prevention: Update. Vancouver: Global Initiative for Asthma. 2012. Available from URL: http://www.inaasthma.org.
Gillisen A. Patient's adherence in asthma. J PhysiolPharmacol. 2007;58(5):205-22.
Ducharme FM. Continuous versus intermittent inhaled corticosteroids for mild persistent asthma in children: not too much, not too little. Thorax. 2012;67(2):102-5.
Turpeinen M, Pelkonen AS, Selroos O, Nikander K, Haahtela T. Continuous versus intermittent inhaled corticosteroids for mild persistent asthma in children: not too much, not too little. Thorax. 2012;67(2):100-2.
Rabe KF, Adachi M, Lai CK, Soriano JB, Vermeire PA, Weiss KB. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy ClinImmunol. 2004;114(1):40-7.
Pando S, Lemière C, Beauchesne MF, Perreault S, Forget A, Blais L. Suboptimal use of inhaled corticosteroids in children with persistent asthma: inadequate prescription, poor drug adherence, or both? Pharmacotherapy. 2010;30(11):1109-16.
Rodrigo GJ, Castro-Rodríguez JA. Daily vs. intermittent inhaled corticosteroids for recurrent wheezing and mild persistent asthma: A systematic review with meta-analysis. Respir Med. 2013;107(8):1133-40.
National Asthma Education and Prevention Program Coordinating Committee. The Expert Panel Report 3 (EPR-3) Summary Report. Guidelines for the diagnosis and management of asthma. New York: National Heart, Lung, and Blood Institute. 2007.
Juniper EF, O’byrne PM, Ferrie PJ, King DR, Roberts JN. Measuring asthma control clinic questionnaire or daily diary? Am J RespirCrit Care Med. 2000;162(4):1330-4.
Leite M, Ponte EV, Petroni J, D'OliveiraJúnior A, Pizzichini E, Cruz AA. Evaluation of the Asthma Control Questionnaire validated for use in Brazil. J Bras Pneumol. 2008;34(10):756-63.
Turpeinen M, Nikander K, Pelkonen AS, Syva¨nen P, Sorva R, Raitio H. Daily versus as-needed inhaled corticosteroid for mild persistent asthma (The Helsinki early intervention childhood asthma study). Arch Dis Child. 2008;93(8):654-9.
Tattersfield AE, Knox AJ, Britton JR, Hall IP. Asthma. Lancet. 2002;360(9342):1313-22.
Boushey HA, Sorkness CA, King TS, Sullivan SD, Fahy JV, Lazarus SC. Daily versus as-needed corticosteroids for mild persistent asthma. N Engl J Med. 2005;352(15):1519-28.
Papi A, Canonica GW, Maestrelli P, Paggiaro P, Olivieri D, Pozzi E. Rescue use of beclomethasone and albuterol in a single inhaler for mild asthma. N Engl J Med. 2007;356(20):2040-52.
Zeiger RS, Mauger D, Bacharier LB, Guilbert TW, Martinez FD, Lemanske RF. Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med. 2011;365(21):1990-2001.
Barnes PJ. Scientific rationale for using a single inhaler for asthma control. Eur Respir J. 2007;29(3):587-95.
Sposato B, Pammolli A, Bove L, Barzan R, Ricci A, Scalese M. A regular or an intermittent treatment for asthma: the long-term effect. Eur Rev Med Pharmacol Sci. 2010;14(12):1037-44.
Ward C, Pais M, Bish R, Reid D, Feltis B, Johns D. Airway inflammation, basement membrane thickening and bronchial hyper responsiveness in asthma. Thorax. 2002;57(4):309-16.
Papi A, Nicolini G, Baraldi E, Boner AL, Cutrera R, Rossi GA. Regular vs prn nebulized treatment in wheeze preschool children. Allergy. 2009;64(10):1463-71.
Zuidgeest MG, Smit HA, Bracke M, Wijga AH, Brunekreef B, Hoekstra MO. Persistence of asthma medication use in preschool children. Respir Med. 2008;102(10):1446-51.
Butz AM, Tsoukleris M, Donithan M, Hsu VD, Mudd K, Zuckerman IH. Patterns of inhaled antiinflammatory medication use in young underserved children with asthma. Pediatrics. 2006;118(6):2504-13.