title: Role of budesonide/formoterol maintenance and reliever therapy: a pragmatic study.
abstract: BACKGROUND
  Many studies have demonstrated the efficacy of budesonide/formoterol (BUD/FORM) for Maintenance and Reliever Therapy (SMART®) for asthma control. However, there are concerns regarding its over-use and effectiveness.
  
  
  OBJECTIVE
  To examine asthma control and over-use of BUD/FORM in real-life situations.
  
  
  METHODS
  This study was a hospital-based cross-sectional and multi-center design. Patients were enrolled if they were >12 years old, had persistent asthma, had received BUD/FORM SMART for 3 months or longer, and smoked less than 10 pack-year.
  
  
  RESULTS
  Of the 792 patients who used BUD/FORM for a mean of 28.2 months, all used BUD/FORM as maintenance and only 22.2% of the patients required BUD/FORM to relieve symptoms. The average inhaled corticosteroid dose used was 355.3±154.9μg/day (95% CI: 344.5 to 366.1). In 792 patients, constituting 2,376 person-months of observations, there was only one patient who used more than 12 puffs/ day of BUD/FORM for 3 days, with a rate of 0.015 days per patient per year (95%CI: 0.003 to 0.044), without reporting any adverse events. The percentage of asthma control according to the Asthma Control Test score of 20 or greater was 86.5% (95% CI: 84.1 to 88.9). Overall, the rates per patient per year of emergency room (ER) visits and hospital admissions were 0.18 and 0.21, respectively.
  
  
  CONCLUSIONS
  BUD/FORM SMART is effective in real-life clinical practice. On average, patients who received a low dose steroid in the form of BUD/FORM, had a satisfactorily high proportion of asthma control and had a low rate of ER visits and hospitalization. BUD/FORM maintenance and reliever therapy seems to be promising as a treatment approach for persistent asthma in every day clinical practice.
authors.affiliation: Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
authors.forename: Watchara
authors.initials: W
authors.lastname: Boonsawat
authors.forename: Bandit
authors.initials: B
authors.lastname: Thinkhamrop
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D004983:Ethanolamines / Q000008:administration & dosage* / Q000009:adverse effects; D055317:Evidence-Based Practice / Q000379:methods*; D005260:Female; D000068759:Formoterol Fumarate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate