title: Comparison of two twice-daily doses of budesonide/formoterol maintenance and reliever therapy.
abstract: The aim of this study was to compare two budesonide/formoterol maintenance doses within the budesonide/formoterol maintenance and reliever therapy concept and to identify possible patient characteristics at baseline which would predict a better response to a higher than standard maintenance dose. A total of 8,424 patients with symptomatic asthma when using an inhaled corticosteroid (ICS) with or without a long-acting β(2)-agonist were randomised to budesonide/formoterol 160/4.5 μg, one (1 × 2) or two (2 × 2) inhalations b.i.d. Patients used the same inhaler as needed for symptom relief. The primary outcome variable was time to first severe asthma exacerbation. In the total study population, the time to first severe asthma exacerbation was prolonged by 18% with 2 × 2 versus 1 × 2 (hazard ratio 0.82; p = 0.03). Lung function (peak expiratory flow) was the only statistically significant predictor of a better response to 2 × 2. The mean daily ICS doses were 737 and 463 μg in the 2 × 2 and 1 × 2 groups, respectively. In a real-life setting, budesonide/formoterol maintenance and reliever therapy at the 2 × 2 maintenance dose did prolong time to first severe exacerbation but at a higher medication load. Patients with low lung function benefited most from the higher maintenance dose.
authors.affiliation: Dept of Pneumology A, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Inserm U700 Faculté de Médecine Denis Diderot, Paris, France. michel.aubier@bch.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Aubier
authors.forename: R
authors.initials: R
authors.lastname: Buhl
authors.forename: T
authors.initials: T
authors.lastname: Ekström
authors.forename: J
authors.initials: J
authors.lastname: Ostinelli
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: O
authors.initials: O
authors.lastname: Selroos
authors.forename: J
authors.initials: J
authors.lastname: Haughney
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D019819:Budesonide / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D012107:Research Design; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate