Advanced

Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction

Lazarinis, Nikolaos; Jorgensen, Leif; Ekstrom, Tommy; Bjermer, Leif LU ; Dahlen, Barbro; Pullerits, Teet; Hedlin, Gunilla; Carlsen, Kai-Hakon and Larsson, Kjell (2014) In Thorax 69(2). p.130-136
Abstract
Background In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting beta(2) agonists (SABAs) on demand. Objective The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand. Methods Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 mu g) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 mu g) + formoterol (6 mu g) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to... (More)
Background In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting beta(2) agonists (SABAs) on demand. Objective The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand. Methods Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 mu g) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 mu g) + formoterol (6 mu g) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication. Results After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% Cl -10.3 to -3.0) and 5.4% (-8.9 to -1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; -2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups. Conclusions The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as regular budesonide treatment despite a substantially lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Thorax
volume
69
issue
2
pages
130 - 136
publisher
BMJ Publishing Group
external identifiers
  • wos:000330108800007
  • scopus:84892554410
ISSN
1468-3296
DOI
10.1136/thoraxjnl-2013-203557
language
English
LU publication?
yes
id
600e3ddc-011a-4f3e-89e8-62aa382fd4b4 (old id 4318608)
date added to LUP
2014-03-03 08:01:20
date last changed
2017-07-09 04:00:16
@article{600e3ddc-011a-4f3e-89e8-62aa382fd4b4,
  abstract     = {Background In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting beta(2) agonists (SABAs) on demand. Objective The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand. Methods Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 mu g) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 mu g) + formoterol (6 mu g) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication. Results After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% Cl -10.3 to -3.0) and 5.4% (-8.9 to -1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; -2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups. Conclusions The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as regular budesonide treatment despite a substantially lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma.},
  author       = {Lazarinis, Nikolaos and Jorgensen, Leif and Ekstrom, Tommy and Bjermer, Leif and Dahlen, Barbro and Pullerits, Teet and Hedlin, Gunilla and Carlsen, Kai-Hakon and Larsson, Kjell},
  issn         = {1468-3296},
  language     = {eng},
  number       = {2},
  pages        = {130--136},
  publisher    = {BMJ Publishing Group},
  series       = {Thorax},
  title        = {Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction},
  url          = {http://dx.doi.org/10.1136/thoraxjnl-2013-203557},
  volume       = {69},
  year         = {2014},
}