title: Routine Use of Budesonide/Formoterol Fixed Dose Combination in Elderly Asthmatic Patients: Practical Considerations.
abstract: Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in older individuals, functional features and clinical presentations may be affected by age per se, and by age-related conditions, such as comorbidities and polypharmacy. In this review article, we aimed to explore the efficacy and safety in elderly asthmatic patients of one of the most currently used inhaled treatments for asthma, that is, the fixed-dose combination of budesonide/formoterol. We attempted to address some practical questions that are relevant to the daily practice of clinicians. We focused on the efficacy and real-world effectiveness of inhaled corticosteroids and long-acting β-adrenergic bronchodilators (ICS/LABA) as treatment in the elderly population, since data are extrapolated from younger populations. We investigated whether a maintenance and reliever therapy approach is more effective in the elderly as opposed to maintenance regimens, from both the general practitioner's and the pulmonologist's perspective. To address these questions, we scanned electronic databases (PubMed, MEDLINE, Embase, Scopus and Google Scholar) from the date of inception up to October 2016 with a cross-search using the following keywords: 'asthma', 'elderly', 'SMART therapy', 'MART therapy', 'Turbuhaler', and 'budesonide/formoterol'. The available literature on the topic confirms that when the age-associated changes are properly managed in clinical practice, asthma in older populations can be optimally controlled with inhaled treatment including ICS/LABA. This also applies for the budesonide/formoterol fixed combination, thus allowing for the maintenance and reliever therapy approach.
authors.affiliation: Department of Biomedicine and Internal and Specialist Medicine, DIBIMIS, University of Palermo, via Trabucco 180, 90146, Palermo, Italy. nicola.scichilone@unipa.it.
authors.forename: Nicola
authors.identifier: 0000-0001-6400-6573
authors.initials: N
authors.lastname: Scichilone
authors.affiliation: Allergy and Respiratory Diseases Department, DIMI, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Braido
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.affiliation: Kenton Bridge Medical Centre, London, UK.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Levy
authors.affiliation: Airway Disease Section, National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, London, UK.
authors.forename: Omar S
authors.initials: OS
authors.lastname: Usmani
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D000069502:Budesonide, Formoterol Fumarate Drug Combination / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016208:Databases, Factual; D004347:Drug Interactions; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D000069502:Budesonide, Formoterol Fumarate Drug Combination