title: Non-pulmonary effects induced by the addition of formoterol to budesonide therapy in patients with mild or moderate persistent asthma.
abstract: OBJECTIVE
  The present study was designed to assess the non-pulmonary effects of a 2-week treatment with the addition of formoterol to budesonide therapy in 10 patients with mild or moderate asthma.
  
  
  METHODS
  Each patient was invited to perform a screening visit which included spirometry before and after inhalation of 12 microg formoterol with a metered dose inhaler (MDI), measurement of arterial blood pressure, baseline electrocardiography and 24-hour Holter monitoring, and a test for evaluating upper limb tremor. Patients then began bronchodilating therapy with 12 microg formoterol MDI and 400 microg budesonide Turbuhaler b.i.d. Each patient was also given a peak flowmeter and a diary in which he had to record the morning and evening values measured before taking inhaled drugs. Two weeks later, the patients repeated the same examinations; the diary card was returned 2 months after the beginning of the study.
  
  
  RESULTS
  Adding formoterol to budesonide therapy caused a significant improvement in lung function, but neither induced any statistically significant effect on mean heart rate, nor altered the circadian rhythm of autonomic regulation nor elicited significant alterations in cardiac morphology. However, the evaluation of upper limb tremor revealed a statistically significant increase (p = 0.02).
  
  
  CONCLUSIONS
  This study shows that adding the recommended dose of formoterol to an inhaled corticosteroid therapy does not induce significant cardiac undesirable effects, although tremor, surely due to stimulation of beta(2) receptors of the skeletal muscles, may sometimes be a limiting effect.
authors.affiliation: Respiratory Disease Unit, University of Milan, San Paolo Hospital, Milan, Italy. stefano.centanni@unimi.it
authors.forename: S
authors.initials: S
authors.lastname: Centanni
authors.forename: P
authors.initials: P
authors.lastname: Carlucci
authors.forename: P
authors.initials: P
authors.lastname: Santus
authors.forename: B
authors.initials: B
authors.lastname: Boveri
authors.forename: D
authors.initials: D
authors.lastname: Tarricone
authors.forename: C
authors.initials: C
authors.lastname: Fiorentini
authors.forename: F
authors.initials: F
authors.lastname: Lombardi
authors.forename: M
authors.initials: M
authors.lastname: Cazzola
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D019819:Budesonide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D000068759:Formoterol Fumarate; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate