Using control drugs “as needed” eases asthma
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For people with asthma who are on a drug combo for regular maintenance therapy, taking the drugs “as needed” when they have symptoms appears to improve overall asthma control, according to a report from the Netherlands.
The role of inhaled corticosteroids, such as budesonide, and long-acting beta-2 agonists, such as formoterol, in controlling asthma have not been fully defined, Dr. Klaus F. Rabe, from the University Medical Centre in Leiden and colleagues point out in the Lancet medical journal. While taking these two types of drugs as maintenance therapy is well established, their benefits when used as needed are unclear.
The new findings are based on a study of 3394 patients with moderate to severe asthma who still had symptoms while taking budesonide/formoterol maintenance therapy during a 2-week trial period. For relief treatment during episodes of breathing difficulty, the subjects were randomly assigned to use the traditional rapid-acting beta-2 agonist terbutaline, or formoterol, or formoterol plus budesonide.
In terms of delaying the first severe asthma flare-up, the drug combination was more effective than formoterol alone, which in turn was more effective than terbutaline.
Formoterol plus budesonide was also significantly better than the other therapies at reducing the rate of severe asthma exacerbations. With this drug combination, 19 severe flare-ups per 100 patients per year occurred compared with 37 and 29 flare-ups with terbutaline and formoterol, respectively.
The results “challenge the established use of maintenance therapy plus rapid-acting beta-2 agonists as the only means of controlling asthma,” Rabe and colleagues conclude.
However, Dr. Soren Pedersen points out in a related editorial that the study group, which featured patients with severe uncontrolled asthma on low-dose combination therapy, represents just “a small proportion of the whole asthma population.”
“Most patients with asthma can achieve guideline-defined asthma control when treated according to (current) recommendations,” Pedersen, from Kolding Hospital in Denmark, notes. “Therefore, generalizing the findings to the whole asthma population seems inappropriate at present.”
SOURCE: Lancet, August 26, 2006.
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