Am. J. Respir. Crit. Care Med., Vol 151, No. 4, Apr 1995, 1053-1057.
Use of a fixed combination beta 2-agonist and steroid dry powder inhaler in asthma
PJ Barnes and BJ O'Connor
Department of Thoracic Medicine, National Heart and Lung Institute, London, UK.
In many countries the majority of patients with asthma are now treated with
inhaled beta 2-agonists as required and regular inhaled steroids.
Compliance with asthma medication is poor, particularly for inhaled
steroids, which do not give immediate relief of symptoms. An inhaler
combining a beta 2-agonist and a steroid may improve compliance and give
better control of asthma. We have studied the effect of a fixed combination
dry powder inhaler (Turbuhaler) containing terbutaline (250 micrograms)
with budesonide (200 micrograms) compared with each drug given alone in a
double-blind, crossover study in 74 patients with mild to moderate asthma.
This was a multicenter study performed in general practice. After a 1-wk
run-in period with placebo inhaler, each treatment was given twice daily
for 4 wk in randomized order. Patients measured symptom scores and rescue
inhaled beta 2-agonist use and recorded peak expiratory flow (PEF) twice
daily. In nine patients recruited to a hospital center, airway
responsiveness was measured by the concentration of methacholine required
to produce a fall in FEV1 of 20% (PC20) at the end of each treatment
period. Of 74 patients randomized, 68 completed all three treatment
periods. Their mean age was 37 (18-60) yr and PEF 80 (43-116) % predicted.
Combination treatment gave a significant improvement in morning and evening
PEF budesonide or terbutaline treatment periods (p < 0.01), and a
significant reduction in asthma symptom scores and rescue beta 2- agonist
use (p < 0.05). There was a significant patient preference for the
combination inhaler.(ABSTRACT TRUNCATED AT 250 WORDS)
