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In moderate and severe asthma, the use of inhaled corticosteroid (ICS)/formoterol maintenance and reliever therapy (MART) reduces the risk of severe exacerbation by about one-third compared with the equivalent dose of ICS/long-acting beta2-agonist (LABA) maintenance plus short-acting beta2-agonist (SABA) reliever therapy.1 This efficacy has not only been demonstrated in populations with tightly defined asthma,1 but also in a high-risk ‘real-world’ population with asthma, which included smokers, and did not require the demonstration of bronchodilator responsiveness.2 The broad population of patients with asthma to whom ICS/formoterol MART is now prescribed is likely to include a substantive proportion who also have clinical characteristics of chronic obstructive pulmonary disease (COPD), previously referred to as the asthma–COPD overlap syndrome.3 Asthma and COPD share many clinical and pathophysiological features,4 and long-standing asthma is a strong risk factor for the development of COPD.5 This leads to the question as to whether the ICS/formoterol MART regimen might also have a favourable risk/benefit profile in COPD.
This issue has been addressed for the first time by Muiser et al,6 who report the findings of a randomised controlled trial (RCT) comparing budesonide/formoterol prescribed according to the MART regimen with double the equivalent ICS dose …
Contributors All authors contributed to the drafting of this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RB has received personal fees from AstraZeneca, Avillion, Cipla and Teva Pharmaceuticals; and is Chair of the New Zealand Asthma & Respiratory Foundation Adolescent and Adult Asthma Guidelines Group. The Medical Research Institute of New Zealand has received research funding from AstraZeneca, Cure Kids (NZ), Genentech and the Health Research Council of New Zealand.
Provenance and peer review Commissioned; externally peer reviewed.