title: Step-down of budesonide/formoterol in early stages of asthma treatment leads to insufficient anti-inflammatory effect.
abstract: OBJECTIVE
  Administration of the combination of an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is the main treatment strategy for bronchial asthma. The ICS/LABA dosage can be reduced (stepped down) when the patient's symptoms and lung functions are well-controlled. In this study, we obtained fractional exhaled nitric oxide (FeNO) measurements to clarify whether the anti-inflammatory effect of budesonide/formoterol is shortened by step-down.
  
  
  METHODS
  Fifty-four patients who visited the Kawasaki Medical School Hospital with newly diagnosed asthma from November 2008 to July 2010 received budesonide/formoterol for 8 weeks or more. In 29 patients, the forced expiratory volume in 1 s% predicted increased to 80% or more, and the Asthma Control Questionnaire (ACQ) score decreased to 0.5 or less within 12 weeks. These 29 patients were randomly divided into two groups: the dosage-continued group (n = 14) and the step-down group (n = 15). Then, the impact of budesonide/formoterol step-down on ACQ score, pulmonary function and FeNO level was compared between the groups.
  
  
  RESULTS
  In the step-down group, the dosage was stepped down from 538 mcg/day to 331 mcg/day. In both groups, pulmonary function indicators and symptoms did not change. However, the mean FeNO level decreased significantly in the dosage-continued group (from 50.9 ppb to 45.0 ppb), and increased significantly in the step-down group (from 51.0 ppb to 65.7 ppb).
  
  
  CONCLUSIONS
  Clinicians should be more careful when stepping down budesonide/formoterol based solely on patients' symptoms and/or pulmonary function.
authors: Department of Respiratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Japan. obaseya@gmail.com
authors: Yasushi
authors: Y
authors: Obase
authors: Masaki
authors: M
authors: Ikeda
authors: Koji
authors: K
authors: Kurose
authors: Masaaki
authors: M
authors: Abe
authors: Hiroki
authors: H
authors: Shimizu
authors: Yoshihiro
authors: Y
authors: Ohue
authors: Keiji
authors: K
authors: Mouri
authors: Shigeki
authors: S
authors: Katoh
authors: Yoshihiro
authors: Y
authors: Kobashi
authors: Mikio
authors: M
authors: Oka
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D001944:Breath Tests; D019819:Budesonide / Q000008:administration & dosage*; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage*; D005541:Forced Expiratory Volume / Q000187:drug effects; D000068759:Formoterol Fumarate; D006801:Humans; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D004983:Ethanolamines; D009569:Nitric Oxide; D019819:Budesonide; D000068759:Formoterol Fumarate