Single inhaler combination of formoterol and budesonide versus inhaled steroid maintenance for chronic asthma
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10.05.2016 • Sonuncu dəyişiklik 10.05.2016
Editors
Single inhaler therapy combining formoterol and budesonide may reduce the risk of asthma exacerbations needing oral corticosteroids compared with inhaled corticosteroids + long-acting beta-agonist but at the cost of more discontinuations due to adverse events.
A Cochrane review included 13 studies with a total of 13 152 adults. There was no difference between single inhaler therapy (budesonide + formoterol) and inhaled corticosteroids (ICS) + long-cting beta-agonist (LABA) in exacerbations causing hospitalisations but the single inhaler therapy reduced exacerbations treated with oral steroids (table ). Discontinuation due to adverse events was more common in the single inhaler group. The results for fatal serious adverse events were too rare to rule out either treatment being harmful.
Budenoside and formoterol single inhaler therapy compared to ICS + LABA
| Outcome (follow-up 6 months) | Relative effect (95% CI) | Assumed risk - Control | Corresponding risk - Single inhaler (95% CI) | Participants (studies) Level of evidence |
| Patients with exacerbations causing hospitalisation
| OR 0.81
(0.45 to 1.44) | 6 per 1000 | 5 per 1000
(3 to 8) | 8841
(8) Low |
| Patients with exacerbations treated with oral steroids
| OR 0.83
(0.70 to 0.98) | 70 per 1000 | 59 per 1000
(50 to 69) | 8841
(8) Moderate |
| Serious adverse events (non-fatal) | OR 1.20
(0.90 to 1.60) | 20 per 1000 | 24 per 1000
(18 to 32 | 8841
(8) Low |
| Discontinuation due to adverse events | OR 2.85
(1.89 to 4.3) | 7 per 1000 | 21 per 1000
(14 to 31) | 8411
(7) Moderate |
Three studies (n=4 209 adults) compared single inhaler therapy with higher dose budesonide maintenance and terbutaline for symptom relief. No significant reduction was found with single inhaler therapy in the risk of patients suffering an asthma exacerbation leading to hospitalisation (Peto OR 0.56; 95% CI 0.28 to 1.09), but fewer patients on single inhaler therapy needed a course of oral corticosteroids (OR 0.54; 95% CI 0.45 to 0.64). These results translate into an eleven month number needed to treat of 14 (95% CI 12 to 18),
to prevent one patient being treated with oral corticosteroids for an exacerbation. The run-in for these studies involved withdrawal of long-acting beta2-agonists, and patients were recruited who were symptomatic during run-in.
Another Cochrane review included 5 studies with a total of 5 537 adult and adolescent participants. There was no difference between single inhaler fluticasone/salmeterol and single inhaler budesonide/formoterol.
Comment: The quality of evidence is downgraded by limitations in study quality (lack of blinding) and by potential reporting bias (all of the included studies are sponsored or supported by the manufacturer of the single inhaler product).
Ədəbiyyat
- Cates CJ, Karner C. Combination formoterol and budesonide as maintenance and reliever therapy versus current best practice (including inhaled steroid maintenance), for chronic asthma in adults and children. Cochrane Database Syst Rev 2013;(4):CD007313. .
- Lasserson TJ, Ferrara G, Casali L. Combination fluticasone and salmeterol versus fixed dose combination budesonide and formoterol for chronic asthma in adults and children. Cochrane Database Syst Rev 2011;(12):CD004106.