Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction

Research output: Contribution to journalArticle

Abstract

Background In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting beta(2) agonists (SABAs) on demand. Objective The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand. Methods Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 mu g) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 mu g) + formoterol (6 mu g) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication. Results After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% Cl -10.3 to -3.0) and 5.4% (-8.9 to -1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; -2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups. Conclusions The combination of budesonide and formoterol on demand improves asthma control by reducing EIB 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 EIB in mild asthma.

Details

Authors
  • Nikolaos Lazarinis
  • Leif Jorgensen
  • Tommy Ekstrom
  • Leif Bjermer
  • Barbro Dahlen
  • Teet Pullerits
  • Gunilla Hedlin
  • Kai-Hakon Carlsen
  • Kjell Larsson
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Respiratory Medicine and Allergy
Original languageEnglish
Pages (from-to)130-136
JournalThorax
Volume69
Issue number2
Publication statusPublished - 2014
Publication categoryResearch
Peer-reviewedYes