Abstract
BackgroundAdjusting medication for uncontrolled asthma involves selecting one of several options from the same or a higher treatment step outlined in asthma guidelines. We examined the relative benefit of introducing budesonide/formoterol (BUD/FORM) maintenance and reliever therapy (Symbicort SMART® Turbuhaler®) in patients previously prescribed treatments from Global Initiative for Asthma (GINA) Steps 2, 3 or 4.MethodsThis is a post hoc analysis of the results of five large clinical trials (>12000 patients) comparing BUD/FORM maintenance and reliever therapy with other treatments categorised by treatment step at study entry. Both current clinical asthma control during the last week of treatment and exacerbations during the study were examined.ResultsAt each GINA treatment step, the proportion of patients achieving target levels of current clinical control were similar or higher with BUD/FORM maintenance and reliever therapy compared with the same or a higher fixed maintenance dose of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) (plus short-acting β2-agonist [SABA] as reliever), and rates of exacerbations were lower at all treatment steps in BUD/FORM maintenance and reliever therapy versus same maintenance dose ICS/LABA (P < 0.01) and at treatment Step 4 versus higher maintenance dose ICS/LABA (P < 0.001). BUD/FORM maintenance and reliever therapy also achieved significantly higher rates of current clinical control and significantly lower exacerbation rates at most treatment steps compared with a higher maintenance dose ICS + SABA (Steps 2-4 for control and Steps 3 and 4 for exacerbations). With all treatments, the proportion of patients achieving current clinical control was lower with increasing treatment steps.ConclusionsBUD/FORM maintenance and reliever therapy may be a preferable option for patients on Steps 2 to 4 of asthma guidelines requiring a more effective treatment and, compared with other fixed dose alternatives, is most effective in the higher treatment steps.
Highlights
Adjusting medication for uncontrolled asthma involves selecting one of several options from the same or a higher treatment step outlined in asthma guidelines
We report here a post hoc analysis of the results of five clinical trials comparing BUD/FORM maintenance and reliever therapy with comparator treatments when introduced in patients on different treatment steps (Steps 2-4) according to Global Initiative for Asthma (GINA) guidelines at study entry
This pooled analysis describes the relative effect of BUD/FORM maintenance and reliever therapy on current asthma control and on exacerbation risk, compared with fixed-dose maintenance regimens of inhaled corticosteroid (ICS) or combination ICS/long-acting b2-agonist (LABA), plus short-acting b2-agonist (SABA) as reliever, in patients with asthma stratified by GINA treatment step at study entry
Summary
Adjusting medication for uncontrolled asthma involves selecting one of several options from the same or a higher treatment step outlined in asthma guidelines. For patients whose asthma is uncontrolled on Step 2 or higher treatment, a recent strategy included in GINA guidelines is the use of a combination inhaler containing budesonide and formoterol for both maintenance therapy and relief of symptoms (option for Steps 3-5). This approach has been shown in several large-scale randomised controlled trials to achieve similar current clinical control of asthma and to be superior to comparators in reducing asthma exacerbations [3,4,5,6,7]. We report here a post hoc analysis of the results of five clinical trials comparing BUD/FORM maintenance and reliever therapy with comparator treatments when introduced in patients on different treatment steps (Steps 2-4) according to GINA guidelines at study entry
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