title: Asthma control in patients receiving inhaled corticosteroid and long-acting beta2-agonist fixed combinations. A real-life study comparing dry powder inhalers and a pressurized metered dose inhaler extrafine formulation.
abstract: BACKGROUND
  Although patients have more problems using metered dose inhalers, clinical comparisons suggest they provide similar control to dry powder inhalers. Using real-life situations this study was designed to evaluate asthma control in outpatients with moderate to severe persistent asthma and to compare efficacy of fixed combinations of inhaled corticosteroids (ICS) and long acting beta-agonists (LABA).
  
  
  METHODS
  This real-life study had a cross-sectional design. Patients using fixed combinations of ICS and LABA had their asthma control and spirometry assessed during regular visits.
  
  
  RESULTS
  111 patients were analyzed: 53 (47.7%) received maintenance therapy of extrafine beclomethasone-formoterol (BDP/F) pressurized metered dose inhaler (pMDI), 25 (22.5%) fluticasone-salmeterol (FP/S) dry powder inhaler (DPI), and 33 (29.7%) budesonide-formoterol (BUD/F) DPI. Severity of asthma at time of diagnosis, assessed by the treating physician, was comparable among groups. Asthma control was achieved by 45.9% of patients; 38.7% were partially controlled and 15.3% were uncontrolled. In the extrafine BDF/F group, asthma control total score, daytime symptom score and rescue medication use score were significantly better than those using fixed DPI combinations (5.8±6.2 vs. 8.5±6.8; 1.4±1.8 vs. 2.3±2.1; 1.8±2.2 vs. 2.6±2.2; p=0.0160; p=0.012 and p=0.025, respectively) and the mean daily ICS dose were significantly lower.
  
  
  CONCLUSIONS
  pMDI extrafine BDP/F combination demonstrated better asthma control compared to DPIs formulated with larger particles. This could be due to the improved lung deposition of the dose or less reliance on the optimal inhalation technique or both.
authors.affiliation: Department of Pulmonology, Semmelweis Medical University, Budapest, Hungary.
authors.forename: Veronika
authors.initials: V
authors.lastname: Müller
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gálffy
authors.forename: Noemi
authors.initials: N
authors.lastname: Eszes
authors.forename: György
authors.initials: G
authors.lastname: Losonczy
authors.forename: Andrea
authors.initials: A
authors.lastname: Bizzi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nicolini
authors.forename: Henry
authors.initials: H
authors.lastname: Chrystyn
authors.forename: Lilla
authors.initials: L
authors.lastname: Tamási
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D001507:Beclomethasone / Q000008:administration & dosage / Q000627:therapeutic use; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D058995:Dry Powder Inhalers; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D004983:Ethanolamines; D019819:Budesonide; D001507:Beclomethasone; D000068759:Formoterol Fumarate