title: Overall asthma control achieved with budesonide/formoterol maintenance and reliever therapy for patients on different treatment steps.
abstract: BACKGROUND
  Adjusting medication for uncontrolled asthma involves selecting one of several options from the same or a higher treatment step outlined in asthma guidelines. We examined the relative benefit of introducing budesonide/formoterol (BUD/FORM) maintenance and reliever therapy (Symbicort SMART® Turbuhaler®) in patients previously prescribed treatments from Global Initiative for Asthma (GINA) Steps 2, 3 or 4.
  
  
  METHODS
  This is a post hoc analysis of the results of five large clinical trials (>12000 patients) comparing BUD/FORM maintenance and reliever therapy with other treatments categorised by treatment step at study entry. Both current clinical asthma control during the last week of treatment and exacerbations during the study were examined.
  
  
  RESULTS
  At each GINA treatment step, the proportion of patients achieving target levels of current clinical control were similar or higher with BUD/FORM maintenance and reliever therapy compared with the same or a higher fixed maintenance dose of inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) (plus short-acting β2-agonist [SABA] as reliever), and rates of exacerbations were lower at all treatment steps in BUD/FORM maintenance and reliever therapy versus same maintenance dose ICS/LABA (P < 0.01) and at treatment Step 4 versus higher maintenance dose ICS/LABA (P < 0.001). BUD/FORM maintenance and reliever therapy also achieved significantly higher rates of current clinical control and significantly lower exacerbation rates at most treatment steps compared with a higher maintenance dose ICS + SABA (Steps 2-4 for control and Steps 3 and 4 for exacerbations). With all treatments, the proportion of patients achieving current clinical control was lower with increasing treatment steps.
  
  
  CONCLUSIONS
  BUD/FORM maintenance and reliever therapy may be a preferable option for patients on Steps 2 to 4 of asthma guidelines requiring a more effective treatment and, compared with other fixed dose alternatives, is most effective in the higher treatment steps.
authors.affiliation: Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Eric.Bateman@uct.ac.za
authors.forename: Eric D
authors.initials: ED
authors.lastname: Bateman
authors.forename: Tim W
authors.initials: TW
authors.lastname: Harrison
authors.forename: Santiago
authors.initials: S
authors.lastname: Quirce
authors.forename: Helen K
authors.initials: HK
authors.lastname: Reddel
authors.forename: Roland
authors.initials: R
authors.lastname: Buhl
authors.forename: Marc
authors.initials: M
authors.lastname: Humbert
authors.forename: Christine R
authors.initials: CR
authors.lastname: Jenkins
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Ollie
authors.initials: O
authors.lastname: Ostlund
authors.forename: Paul M
authors.initials: PM
authors.lastname: O'Byrne
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Sears
authors.forename: Göran S
authors.initials: GS
authors.lastname: Eriksson
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000704:Analysis of Variance; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D000069502:Budesonide, Formoterol Fumarate Drug Combination; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005541:Forced Expiratory Volume; D000068759:Formoterol Fumarate; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D009330:Nebulizers and Vaporizers; D016017:Odds Ratio; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D000069502:Budesonide, Formoterol Fumarate Drug Combination; D004338:Drug Combinations; D004983:Ethanolamines; D005938:Glucocorticoids; D019819:Budesonide; D000068759:Formoterol Fumarate