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Asthma: combination of Budesonide and Formoterol on demand improves control by reducing exercise-induced bronchoconstriction


In mild asthma exercise-induced bronchoconstriction is usually treated with inhaled short-acting beta2-agonists ( SABAs ) on demand.

The hypothesis was that a combination of Budesonide and Formoterol ( Symbicort ) on demand diminishes exercise-induced bronchoconstriction equally to regular inhalation of Budesonide and is more effective than Terbutaline ( Bricanyl ) inhaled on demand.

Sixty-six patients with asthma ( greater than 12 years of age ) with verified exercise-induced bronchoconstriction were randomised to Terbutaline ( 0.5 mg ) on demand, regular Budesonide ( 400 mcg ) ( Pulmicort, Pulmaxan ) and Terbutaline ( 0.5 mg ) on demand, or a combination of Budesonide ( 200 mcg ) plus Formoterol ( 6 mcg ) on demand in a 6-week, double-blind, parallel-group study.
The patients were instructed to perform three to four working sessions per week. The main outcome was exercise-induced bronchoconstriction 24 h after the last dosing of study medication.

After 6 weeks of treatment with regular Budesonide or Budesonide plus Formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% and 5.4% smaller, respectively.
This effect was superior to inhalation of Terbutaline on demand ( +1.5% ).
The total Budesonide dose was approximately 2.5 times lower in the Budesonide plus Formoterol group than in the regular Budesonide group.
The need for extra medication was similar in the three groups.

In conclusion, the combination of Budesonide and Formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction in the same order of magnitude as regular Budesonide treatment despite a substantially lower total steroid dose.
Both these treatments were superior to Terbutaline on demand, which did not alter the bronchial response to exercise.
The results question the recommendation of prescribing SABAs as the only treatment for exercise-induced bronchoconstriction in mild asthma. ( Xagena )

Lazarinis N et al, Thorax 2014; 69:130-136

XagenaMedicine_2014



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