title: Achieving asthma control with ICS/LABA: A review of strategies for asthma management and prevention.
abstract: Maintenance treatment with an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) is recommended for patients whose asthma is not controlled with a low-to-moderate dose of ICS alone; a separate reliever medication is used on an as-needed basis. The Gaining Optimal Asthma ControL (GOAL) study demonstrated that salmeterol/fluticasone maintenance treatment can improve asthma control and reduce future risk compared with fluticasone alone, although the dose escalation design of this study meant that most patients treated with salmeterol/fluticasone were receiving the highest dose of ICS at the end of the study. Similarly, budesonide/formoterol maintenance therapy improved asthma control and reduced future risk compared with budesonide alone in the Formoterol and Corticosteroids Establishing Therapy (FACET) study. An alternative approach to asthma management is to use an ICS/LABA for both maintenance and reliever therapy. A large body of clinical evidence has shown that the use of budesonide/formoterol in this way improves both current control and reduces future risk compared with ICS/LABA plus as-needed short-acting β2-agonist (SABA), even when patients receive lower maintenance doses of ICS as part of the maintenance and reliever therapy regimen. In addition, one study has shown that beclometasone/formoterol maintenance and reliever therapy reduces exacerbations more effectively than beclometasone/formoterol plus as-needed SABA. The use of ICS/LABA as both maintenance and reliever therapy ensures that an increase in reliever use in response to worsening symptoms is automatically matched by an increase in ICS.
authors.affiliation: Martini Hospital, PO Box 30033, 9700 RM Groningen, The Netherlands. Electronic address: longleven@hotmail.com.
authors.forename: René
authors.initials: R
authors.lastname: Aalbers
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043 Marburg, Germany; German Center for Lung Research (DZL), Germany. Electronic address: claus.vogelmeier@med.uni-marburg.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: Department of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, ul. Kopcińskiego 22, 90-153 Łódź, Poland. Electronic address: piotr.kuna@umed.lodz.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kuna
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000517:prevention & control; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068759:Formoterol Fumarate / Q000627:therapeutic use*; D006801:Humans
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D019819:Budesonide; D000068759:Formoterol Fumarate
keywords: Asthma; Beclometasone; Budesonide; Formoterol; ICS/LABA; Maintenance and reliever therapy