מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – In steroid-free mild asthmatics, budesonide treatment reduces exacerbation. In patients already receiving budesonide, the addition of formoterol can also provide improvements, according to a study of almost 2000 patients.
Dr. Paul M. O'Byrne of McMaster University, Hamilton, Ontario, Canada, and colleagues in Europe note that the effect of combining low-dose inhaled corticosteroids with long-acting beta-agonists has never been evaluated in mild asthmatics.
To do so, the researchers studied 698 corticosteroid-free patients who were randomized to twice-daily treatment with 100 mcg of budesonide alone, 100 mcg of budesonide and 4.5 mcg of formoterol, or placebo.
Another 1272 corticosteroid-treated patients were also randomized to one of the above treatment groups or to two other treatment groups. The two additional treatment arms included twice daily treatment with 200 mcg of budesonide or 200 mcg of budesonide plus formoterol 4.5 mcg. There was no placebo group.
At the end of the 1-year study, the researchers found that addition of budesonide alone in initially steroid-free patients reduced the risk of severe exacerbations by 60% and cut the number of days with poor asthma control by 48%. Adding formoterol improved lung function, but did not affect these outcome measures.
In the steroid-treated patients, however, addition of formoterol cut the risk of severe exacerbations by 43% and "poorly controlled days" by 30%. Furthermore, adding formoterol to the lower dose of budesonide was more effective in achieving these end points than was doubling of the budesonide dose.
In light of these findings, which appeared in the October 15th issue of the American Journal of Respiratory and Critical Care Medicine, the researchers point out that "mild asthma may often be undertreated."
Addition of formoterol can be helpful in patients already receiving corticosteroids. However, budesonide alone may be enough in those not previously receiving corticosteroids. In such patients, they conclude, "only if optimal control is not achieved should additional therapy with formoterol be considered."
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