People with mild asthma are often prescribed a daily treatment regimen, but up to 80 per cent do not follow the routine, using inhalers only when they have an asthma attack. Now the researchers have found an as-needed combined-drug inhaler is a viable treatment option.
The principal investigator on the study that suggests an inhaler with a combination of budesonide, a steroid that controls inflammation, and formoterol, a beta2-agonist that helps to open airways and make breathing easier, may be an alternative to conventional treatment strategies. The results were published in the journal, The New England Journal of Medicine (NEJM).
The team worked with researchers around the world to conduct a 52-week trial with patients aged 12 years of age of older with clinically-diagnosed mild asthma.
More than 3,800 patients participated from countries including Canada, China, the United Kingdom, Australia, Brazil and South Africa, among others. The trial was conducted between July 2014 and August 2017.
Patients were randomly assigned one of three regimens and were closely monitored. One group took a twice-daily placebo plus as-needed terbutaline, a relief beta agonist used to prevent and treat wheezing; a second group was on a twice-daily placebo plus budesonide-formoterol used as needed, while a third group was on twice-daily maintenance budesonide plus terbutaline used as needed. All patients received an electronic reminder to take their maintenance treatment twice daily.
The trial results showed budesonide-formoterol used as needed was superior to terbutaline alone as needed for improving asthma symptom control, as well as reducing the risk of an asthma attacks by more than 60 per cent, but was inferior to the twice-daily budesonide maintenance therapy for symptom control.
"If patients could remember to take their maintenance budesonide treatment and follow it carefully, they would get the best day-to-day symptom control, but the risk of exacerbation was the same as if they used the combined budesonide and formoterol as needed," said the senior author.
"In addition, the amount of steroids used was much less when the combined inhaler was used, because the patient did not need to take it every day."
In another study also published in NEJM patients were randomly assigned a twice-daily placebo plus budesonide-formoterol used as needed or twice-daily budesonide plus terbutaline used as needed.
The trial involved more than 4,200 patients on a 52-week trial in 25 countries between November 2014 and August 2017. As with the other study, participants had mild asthma and were aged 12 and older.
The results showed that in patients with mild asthma, budesonide-formoterol used as needed was comparable to twice-daily budesonide in relation to the rate of severe asthma attacks during 52 weeks of treatment, but was inferior in controlling symptoms.
"This was more of a real-world study, without the electronic monitoring twice a day or reminders to use medication, and fewer study visits, so it is more comparable to managing patients in a real facility with a lower adherence to the daily treatment course," said the author.
"There was no short-acting beta-agonists comparator group in this trial, just the comparison of the maintenance budesonide to the reliever that contained budesonide-formoterol, but the trial outcomes were essentially identical."
Alternative treatment for mild asthma!
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