title: Effect of different asthma treatments on risk of cold-related exacerbations.
abstract: Common colds often trigger asthma exacerbations. The present study compared cold-related severe exacerbations during budesonide/formoterol maintenance and reliever therapy, and different regimens of maintenance inhaled corticosteroids (ICS), with or without long-acting β(2)-agonists (LABA), and with as-needed short-acting β(2)-agonists (SABA) or LABA. Reported colds and severe exacerbations (defined by oral corticosteroid use and/or hospitalisation/emergency room visit) were assessed for 12,507 patients during 6-12 months of double-blind treatment. Exacerbations occurring ≤14 days after onset of reported colds were analysed by a Poisson model. The incidence of colds was similar across treatments. Asthma symptoms and reliever use increased during colds. Budesonide/formoterol maintenance and reliever therapy reduced severe cold-related exacerbations by 36% versus pooled comparators plus SABA (rate ratio (RR) 0.64; p=0.002), and for individual treatment comparisons, by 52% versus the same maintenance dose of ICS/LABA (RR 0.48; p<0.001); there were nonsignificant reductions versus higher maintenance doses of ICS or ICS/LABA (RR 0.83 and 0.72, respectively). As-needed LABA did not reduce cold-related exacerbations versus as-needed SABA (RR 0.96). Severe cold-related exacerbations were reduced by budesonide/formoterol maintenance and reliever therapy compared with ICS with or without LABA and with as-needed SABA. Subanalyses suggested the importance of the ICS component in reducing cold-related exacerbations. Future studies should document the cause of exacerbations, in order to allow identification of different treatment effects.
authors.affiliation: Woolcock Institute of Medical Research, Australia. hkr@med.usyd.edu.au
authors.forename: H K
authors.initials: HK
authors.lastname: Reddel
authors.forename: C
authors.initials: C
authors.lastname: Jenkins
authors.forename: S
authors.initials: S
authors.lastname: Quirce
authors.forename: M R
authors.initials: MR
authors.lastname: Sears
authors.forename: E D
authors.initials: ED
authors.lastname: Bateman
authors.forename: P M
authors.initials: PM
authors.lastname: O'Byrne
authors.forename: M
authors.initials: M
authors.lastname: Humbert
authors.forename: R
authors.initials: R
authors.lastname: Buhl
authors.forename: T
authors.initials: T
authors.lastname: Harrison
authors.forename: G G
authors.initials: GG
authors.lastname: Brusselle
authors.forename: A
authors.initials: A
authors.lastname: Thorén
authors.forename: U
authors.initials: U
authors.lastname: Sjöbring
authors.forename: S
authors.initials: S
authors.lastname: Peterson
authors.forename: O
authors.initials: O
authors.lastname: Ostlund
authors.forename: G S
authors.initials: GS
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications* / Q000628:therapy*; D019819:Budesonide / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000150:complications*; D004311:Double-Blind Method; D004983:Ethanolamines / Q000008:administration & dosage; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate