Efficacy of budesonide/formoterol maintenance and reliever therapy compared with higher-dose budesonide as step-up from low-dose inhaled corticosteroid treatment

• Main Authors: Christine R. Jenkins, Göran Eriksson, Eric D. Bateman, Helen K. Reddel, Malcolm R. Sears, Magnus Lindberg, Paul M. O’Byrne
• Format: Article
• Language: English
• Published: BMC 2017-04-01
• Series: BMC Pulmonary Medicine
• Subjects: Asthma; Bronchodilators; Corticosteroids; Respiratory therapy; Therapy
• Online Access: http://link.springer.com/article/10.1186/s12890-017-0401-y

Abstract Background Asthma management may involve a step up in treatment when symptoms are not well controlled. We examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher, fixed-dose budesonide plus as-needed terbutaline in patients requiring step-up from Step 2 treatment (low-dose inhaled corticosteroids), stratified by baseline reliever use. Methods A post-hoc analysis utilized data from three clinical trials of 6–12 months’ duration. Patients aged ≥12 years with symptomatic asthma uncontrolled despite Step 2 treatment were included. Severe exacerbation rate, lung function and reliever use were analysed, stratified by baseline reliever use (<1, 1–2 and >2 occasions/day). Results Overall, 1239 patients were included. Reductions in severe exacerbation rate with budesonide/formoterol MRT versus fixed-dose budesonide were similar across baseline reliever use levels, and were statistically significant in patients using 1–2 (42%, p = 0.01) and >2 (39%, p = 0.02) reliever occasions/day, but not <1 reliever occasion/day (35%, p = 0.11). Both treatments significantly increased mean FEV1 from baseline; improvements were significantly greater for budesonide/formoterol MRT in all reliever use groups. Reductions in reliever use from baseline were significantly greater with budesonide/formoterol MRT versus fixed-dose budesonide in patients using 1–2 and >2 reliever occasions/day (−0.33 and −0.74 occasions/day, respectively). Conclusions Treatment benefit with budesonide/formoterol MRT versus higher, fixed-dose budesonide plus short-acting β2-agonist was found in Step 2 patients with relatively low reliever use, supporting the proposal that budesonide/formoterol MRT may be useful when asthma is uncontrolled with low-dose inhaled corticosteroid.