help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on October 22, 2004, doi:10.1164/rccm.200407-884OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 2, January 2005, 129-136

A more recent version of this article appeared on January 15, 2005
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200407-884OCv1
171/2/129    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by O'Byrne, P. M
Right arrow Articles by Bateman, E. D
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by O'Byrne, P. M
Right arrow Articles by Bateman, E. D

Submitted on July 8, 2004
Accepted on October 18, 2004

Budesonide/Formoterol Combination Therapy as Both Maintenance and Reliever Medication in Asthma

Paul M O'Byrne1*, Hans Bisgaard2, Philippe P Godard3, Massimo Pistolesi4, Mona Palmqvist5, Yuanjue Zhu6, Tommy Ekstrom7, and Eric D Bateman8

1 Firestone Institute for Respiratory Health, St. Joseph's Hospital, Hamilton, Ontario, Canada, 2 COPSAC Clinical Research Unit, University Hospital of Copenhagen, Copenhagen, Denmark, 3 Services des Maladies Respiratories and Bronchomotricite, Hopital Arnaud de Villeneuve, Montpellier, France, 4 Department of Critical Care, Section of Respiratory Medicine, University of Florence, Florence, Italy, 5 Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden, 6 Respiratory Department, Peking Union Medical College Hospital, Beijing, China, 7 AstraZeneca Research and Development, Lund, Sweden, 8 University of Cape Town, Cape Town, South Africa

* To whom correspondence should be addressed. E-mail: obyrnep{at}mcmaster.ca.

Asthma control is improved by combining inhaled corticosteroids with long-acting beta2-agonists. However, fluctuating asthma control still occurs. We hypothesized that, in patients receiving low maintenance dose budesonide/formoterol (bud/form), replacing short-acting beta2-agonist (SABA) reliever with as-needed bud/form would provide rapid symptom relief and simultaneous adjustment in anti-inflammatory therapy, thereby reducing exacerbations. In this double-blind, randomized, parallel-group study, 2760 asthma patients aged 4 to 80 years (forced expiratory volume in 1 second [FEV1] 60 to 100% predicted) received either terbutaline 0.4 mg as SABA with bud/form 80/4.5 ug bid (bud/form + SABA) or bud 320 ug bid (bud + SABA), or bud/form 80/4.5 ug bid with 80/4.5 ug as-needed (bud/form maintenance + relief). Children used a once-nocte maintenance dose. Bud/form maintenance + relief prolonged time to first severe exacerbation (p < 0.001; primary endpoint), resulting in a 45-47% lower exacerbation risk vs. bud/form + SABA (hazard ratio [HR]: 0.55; 95% confidence interval (CI): 0.44, 0.67) or bud + SABA (HR: 0.53; 95% CI: 0.43, 0.65). Bud/form maintenance + relief also prolonged the time to the first, second, and third exacerbation requiring medical intervention (p < 0.001), reduced severe exacerbation rate, and improved symptoms, awakenings, and lung function compared with both fixed dosing regimens. Thus, using budesonide/formoterol for both maintenance and relief reduces the morbidity of ashma when compared with traditional fixed dosing regimens.
Key words: inhaled corticosteroids, long-acting beta2-agonists, management, single inhaler




This article has been cited by other articles:


Home page
 BMJHome page
H. Pinnock
A man with poorly controlled asthma and exercise induced symptoms
BMJ, October 22, 2008; 337(oct22_2): a1963 - a1963.
[Full Text]

Home page
 Therapeutic Advances in Respiratory DiseaseHome page
B. Lindmark
Review: Differences in the pharmacodynamics of budesonide/formoterol and salmeterol/fluticasone reflect differences in their therapeutic usefulness in asthma
Therapeutic Advances in Respiratory Disease, October 1, 2008; 2(5): 279 - 299.
[Abstract] [PDF]

Home page
 ThoraxHome page
A. Sykes, T. Seemungal, and ICEAD contributors
Recent advances in exacerbations of asthma
Thorax, September 1, 2008; 63(9): 758 - 760.
[Full Text] [PDF]

Home page
 Therapeutic Advances in Respiratory DiseaseHome page
L. Bjermer
Review: Evaluating combination therapies for asthma: pros, cons, and comparative benefits
Therapeutic Advances in Respiratory Disease, June 1, 2008; 2(3): 149 - 161.
[Abstract] [PDF]

Home page
 Eur Respir JHome page
S. Suissa, P. Ernst, K. L. Vandemheen, and S. D. Aaron
Methodological issues in therapeutic trials of COPD
Eur. Respir. J., May 1, 2008; 31(5): 927 - 933.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
M. R. Sears, L-P. Boulet, M. Laviolette, J. M. Fitzgerald, T. R. Bai, A. Kaplan, N. Smiljanic-Georgijev, and J. S-M. Lee
Budesonide/formoterol maintenance and reliever therapy: impact on airway inflammation in asthma
Eur. Respir. J., May 1, 2008; 31(5): 982 - 989.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
I Sabroe, L C Parker, P M A Calverley, S K Dower, and M K B Whyte
Pathological networking: a new approach to understanding COPD
Postgrad. Med. J., May 1, 2008; 84(991): 259 - 264.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
N. A. Hanania
Targeting Airway Inflammation in Asthma: Current and Future Therapies
Chest, April 1, 2008; 133(4): 989 - 998.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
E. D. Bateman, S. S. Hurd, P. J. Barnes, J. Bousquet, J. M. Drazen, M. FitzGerald, P. Gibson, K. Ohta, P. O'Byrne, S. E. Pedersen, et al.
Global strategy for asthma management and prevention: GINA executive summary
Eur. Respir. J., January 1, 2008; 31(1): 143 - 178.
[Abstract] [Full Text] [PDF]

Home page
 Mol. Pharmacol.Home page
M. Kaur, J. E. Chivers, M. A. Giembycz, and R. Newton
Long-Acting 2-Adrenoceptor Agonists Synergistically Enhance Glucocorticoid-Dependent Transcription in Human Airway Epithelial and Smooth Muscle Cells
Mol. Pharmacol., January 1, 2008; 73(1): 203 - 214.
[Abstract] [Full Text] [PDF]

Home page
 Evid. Based Med.Home page
P J. Rees
Symptomatic use of beclomethasone-albuterol and regular use of beclomethasone did not differ for control of mild asthma
Evid. Based Med., December 1, 2007; 12(6): 173 - 173.
[Full Text] [PDF]

Home page
 Therapeutic Advances in Respiratory DiseaseHome page
M. Cazzola and M. G. Matera
Review: Safety of long-acting {beta}2 -agonists in the treatment of asthma
Therapeutic Advances in Respiratory Disease, October 1, 2007; 1(1): 35 - 46.
[Abstract] [PDF]

Home page
 BMJHome page
P. J Barnes
Using a combination inhaler (budesonide plus formoterol) as rescue therapy improves asthma control
BMJ, September 8, 2007; 335(7618): 513 - 513.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
P. M. O'Byrne
How much is too much? The treatment of mild asthma
Eur. Respir. J., September 1, 2007; 30(3): 403 - 406.
[Full Text] [PDF]

Home page
 ThoraxHome page
I. Sabroe, L. C Parker, P. M A Calverley, S. K Dower, and M. K B Whyte
Pathological networking: a new approach to understanding COPD
Thorax, August 1, 2007; 62(8): 733 - 738.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
A. Papi, G. W. Canonica, P. Maestrelli, P. Paggiaro, D. Olivieri, E. Pozzi, N. Crimi, A. M. Vignola, P. Morelli, G. Nicolini, et al.
Rescue Use of Beclomethasone and Albuterol in a Single Inhaler for Mild Asthma
N. Engl. J. Med., May 17, 2007; 356(20): 2040 - 2052.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
K. M. Beeh, E. Derom, F. Kanniess, R. Cameron, M. Higgins, and A. van As
Indacaterol, a novel inhaled {beta}2-agonist, provides sustained 24-h bronchodilation in asthma
Eur. Respir. J., May 1, 2007; 29(5): 871 - 878.
[Abstract] [Full Text] [PDF]

Home page
 cfpHome page
A. D. Bell and R. A. McIvor
The SMART study
Can Fam Physician, April 1, 2007; 53(4): 687 - 688.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
W. C. Moore and S. P. Peters
Update in Asthma 2006
Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 649 - 654.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
P. J. Barnes
Scientific rationale for using a single inhaler for asthma control
Eur. Respir. J., March 1, 2007; 29(3): 587 - 595.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
H. Bisgaard, P. Le Roux, D. Bjamer, A. Dymek, J. H. Vermeulen, and C. Hultquist
Budesonide/Formoterol Maintenance Plus Reliever Therapy: A New Strategy in Pediatric Asthma
Chest, December 1, 2006; 130(6): 1733 - 1743.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
P. Ernst, A. McIvor, F. M. Ducharme, L.-P. Boulet, M. FitzGerald, K. R. Chapman, T. Bai, and for the Canadian Asthma Guideline Group
Safety and effectiveness of long-acting inhaled beta-agonist bronchodilators when taken with inhaled corticosteroids.
Ann Intern Med, November 7, 2006; 145(9): 692 - 694.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
T. Haahtela, K. Tamminen, L. P. Malmberg, O. Zetterstrom, J. Karjalainen, H. Yla-Outinen, T. Svahn, T. Ekstrom, and O. Selroos
Formoterol as needed with or without budesonide in patients with intermittent asthma and raised NO levels in exhaled air: a SOMA study
Eur. Respir. J., October 1, 2006; 28(4): 748 - 755.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
A. Bell and R. A. McIvor
SMART therapy.
Can. Med. Assoc. J., August 1, 2006; 175(3): 276 - 277.
[Full Text] [PDF]

Home page
 ThoraxHome page
C A Slader, H K Reddel, L M Spencer, E G Belousova, C L Armour, S Z Bosnic-Anticevich, F C K Thien, and C R Jenkins
Double blind randomised controlled trial of two different breathing techniques in the management of asthma
Thorax, August 1, 2006; 61(8): 651 - 656.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
I. N. Chinn, M. D. Railey, and L. W. Williams
Budesonide/Formoterol Combination Therapy as Both Maintenance and Reliever Medication in Asthma
Pediatrics, August 1, 2006; 118(Supplement_1): S42 - S43.
[Abstract] [PDF]

Home page
 Eur Respir JHome page
H. K. Reddel and D. J. Barnes
Pharmacological strategies for self-management of asthma exacerbations.
Eur. Respir. J., July 1, 2006; 28(1): 182 - 199.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
J. Glassroth
The Role of Long-Acting {beta}-Agonists in the Management of Asthma: Analysis, Meta-Analysis, and More Analysis
Ann Intern Med, June 20, 2006; 144(12): 936 - 937.
[Full Text] [PDF]

Home page
 Am. J. Respir. Cell Mol. Bio.Home page
M. R. Edwards, M. W. Johnson, and S. L. Johnston
Combination Therapy: Synergistic Suppression of Virus-Induced Chemokines in Airway Epithelial Cells
Am. J. Respir. Cell Mol. Biol., May 1, 2006; 34(5): 616 - 624.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
S. E. Wenzel and R. Covar
Update in asthma 2005.
Am. J. Respir. Crit. Care Med., April 1, 2006; 173(7): 698 - 706.
[Full Text] [PDF]

Home page
 ChestHome page
K. Parameswaran
Treatment Strategy for Asthma: One for All and All for One?
Chest, February 1, 2006; 129(2): 221 - 223.
[Full Text] [PDF]

Home page
 ChestHome page
K. F. Rabe, E. Pizzichini, B. Stallberg, S. Romero, A. M. Balanzat, T. Atienza, P. A. Lier, and C. Jorup
Budesonide/Formoterol in a Single Inhaler for Maintenance and Relief in Mild-to-Moderate Asthma: A Randomized, Double-Blind Trial.
Chest, February 1, 2006; 129(2): 246 - 256.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
P. M. O'Byrne and E. Adelroth
{beta}2 Deja Vu
Chest, January 1, 2006; 129(1): 3 - 5.
[Full Text] [PDF]

Home page
 ERRHome page
P. Barnes, J. C. Virchow, J. Sanchis, T. Welte, and S. Pedersen
Asthma management: important issues
Eur. Respir. Rev., December 1, 2005; 14(97): 147 - 151.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
C. Vogelmeier, A. D'Urzo, R. Pauwels{dagger}, J. M. Merino, M. Jaspal, S. Boutet, I. Naya, and D. Price
Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?
Eur. Respir. J., November 1, 2005; 26(5): 819 - 828.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
G. P. Currie, D. K. C. Lee, and P. Srivastava
Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma?
Chest, October 1, 2005; 128(4): 2954 - 2962.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. M. O'Byrne
Daily Inhaled Corticosteroid Treatment Should Be Prescribed for Mild Persistent Asthma
Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 410 - 412.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
H. A. Boushey
Rebuttal from Dr. Boushey
Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 415 - 415.
[Full Text] [PDF]

Home page
 Evid. Based Med.Home page
P J. Rees
Maintenance plus as needed budesonide plus formoterol was better than fixed dose for severe exacerbations in asthma
Evid. Based Med., August 1, 2005; 10(4): 116 - 116.
[Full Text] [PDF]

Home page
 Evid. Based Nurs.Home page
S. A Bruce and Y. K Scherer
Maintenance and symptom relief with budesonide plus formoterol reduced severe asthma exacerbations
Evid. Based Nurs., July 1, 2005; 8(3): 78 - 78.
[Full Text] [PDF]

Home page
 BMJHome page
G. P Currie, G. S Devereux, D. K C Lee, and J. G Ayres
Recent developments in asthma management
BMJ, March 12, 2005; 330(7491): 585 - 589.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
P. G. Gibson
Teaching old drugs new tricks: asthma therapy adjusted by patient perception or noninvasive markers
Eur. Respir. J., March 1, 2005; 25(3): 397 - 399.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
P. J. Barnes
A Single Inhaler for Asthma?
Am. J. Respir. Crit. Care Med., January 15, 2005; 171(2): 95 - 96.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2004 American Thoracic Society 		  ATS Clinical Skills Tests