Randomised trial of an inhaled 
2 agonist, inhaled
corticosteroid and their combination in the treatment of asthma
R J Hancox, aJ O Cowan, aE M Flannery, aG P Herbison, bC R McLachlan, aC S Wong, aD R Taylora
a Department of
Medicine, b Department of Preventive and Social Medicine, c University of Otago, P
O Box 913, Dunedin, New Zealand
Correspondence to: Dr D R Taylor.
Received 31 March 1998; Returned to authors 23 July 1998; Revised version received 7 September 1998; Accepted for publication 17 September 1998
BACKGROUND
Although
many asthmatic patients are treated with a combination of
2 agonist and corticosteroid inhalers, the clinical
effects of combining the drugs are unknown. Studies on the early
asthmatic response to allergen suggest that 2 agonists
may reduce the benefit of inhaled corticosteroids. A study of the
effects of combining the drugs on asthma control was undertaken.
METHODSSixty one
subjects with mild to moderate asthma were randomised to a double blind
crossover comparison of inhaled budesonide (200-400 µg twice
daily), terbutaline (500-1000 µg four times daily), combined
treatment, and placebo. Each treatment was given for six weeks
following a four week washout period. Ipratropium was used for symptom
relief. Treatments were ranked from worst (1) to best (4) based on need
for oral steroid, mean morning peak flow, nocturnal awakening,
ipratropium use, and asthma symptoms. Lung function and bronchial
hyperresponsiveness were measured before and after each treatment.
RESULTSEvaluable
data for all four treatments were obtained from 47 subjects. The mean
rank of each treatment was: placebo = 2.05; terbutaline = 2.13;
budesonide = 2.48; combined treatment = 3.34. Combined treatment was
ranked significantly better than any other treatment (p<0.01). Mean
(95% CI) morning and evening peak flows were 14 (5 to 23) and 24 (15 to 34) l/min higher, respectively, during combined treatment than
during budesonide, and 27 (17 to 37) and 15 (7 to 23) l/min higher
than during terbutaline. Asthma symptoms tended to be least frequent
during combined treatment but were not significantly different from
budesonide alone. There was no significant difference between combined
treatment and budesonide alone for lung function and bronchial hyperresponsiveness.
CONCLUSIONSIn
this group of mild to moderate asthmatic subjects the combination of
2 agonist and corticosteroid gave better asthma control than either treatment alone. There was no evidence that regular 2 agonist treatment impaired the beneficial effect of
inhaled corticosteroid.
Keywords: asthma; inhaled
2 agonists;
inhaled
corticosteroids
© 1999 by Thorax
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