Chest
Volume 123, Issue 5, May 2003, Pages 1480-1487
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Clinical Investigations
ASTHMA
Budesonide and Formoterol in a Single Inhaler Improves Asthma Control Compared With Increasing the Dose of Corticosteroid in Adults With Mild-to-Moderate Asthma

https://doi.org/10.1378/chest.123.5.1480Get rights and content

Background:

We evaluated the efficacy and safety of low-dose budesonide/formoterol, 80 μg/4.5 μg, bid in a single inhaler (Symbicort Turbuhaler; AstraZeneca; Lund, Sweden) compared with an increased dose of budesonide, 200 μg bid, in adult patients with mild-to-moderate asthma not fully controlled on low doses of inhaled corticosteroid alone.

Methods:

All patients received budesonide, 100 μg bid, during a 2-week run-in period. At the end of the run-in phase, 467 patients with a mean FEV1 of 82% predicted received 12 weeks of treatment with budesonide/formoterol in a single inhaler or budesonide alone in a higher dose. Patients kept daily records of their morning and evening peak expiratory flow (PEF), nighttime and daytime symptom scores, and use of reliever medication.

Results:

The increase in mean morning PEF—the primary efficacy measure—was significantly higher for budesonide/formoterol compared with budesonide alone (16.5 L/min vs 7.3 L/min, p = 0.002). Similarly, evening PEF was significantly greater in the budesonide/formoterol group (p < 0.001). In addition, the percentage of symptom-free days and asthma-control days (p = 0.007 and p = 0.002, respectively) were significantly improved in the budesonide/formoterol group. Budesonide/formoterol decreased the relative risk of an asthma exacerbation by 26% (p = 0.02) compared with budesonide alone. Adverse events were comparable between the two treatment groups.

Conclusion:

This study shows that in adult patients whose mild-to-moderate asthma is not fully controlled on low doses of inhaled corticosteroids, single-inhaler therapy with budesonide and formoterol provides greater improvements in asthma control than increasing the maintenance dose of inhaled corticosteroid.

Section snippets

Materials and Methods

This was a double-blind, randomized, parallel-group, multinational study conducted at 51 centers in the Czech Republic, Hungary, Norway, Poland, South Africa, Sweden, and United Kingdom. The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines, and local regulations, each study center having received ethical approval of the protocol prior to study commencement. All patients gave written informed consent.

Results

Of the 494 patients who entered the open 2-week run-in period, 467 patients (200 men and 267 women) aged 18 to 78 years (mean, 41 years) were randomized to the study. A total of 37 patients discontinued the study: 15 patients in the budesonide/formoterol group (6 with asthma deterioration, 3 with adverse events, and 6 for other reasons) and 22 patients in the budesonide-alone group (5 with asthma deterioration, 3 with adverse events, and 14 for other reasons).

Overall, baseline demographics and

Discussion

The results of this study demonstrate that patients with mild-to-moderate asthma not fully controlled on low doses of inhaled corticosteroid (200 μg/d) benefit significantly from treatment with low-dose budesonide/formoterol compared with raising the dose of corticosteroid alone. These results provide further evidence in support of adding a long-acting β2-agonist to low-dose inhaled corticosteroid before increasing the dose of inhaled corticosteroid in patients who are not fully controlled on

ACKNOWLEDGMENT

The authors thank Caroline Hewitt for coordinating the data from AstraZeneca and author contributions from the seven countries in this multinational study, and the patients in the 51 participating centers in the Czech Republic, Hungary, Norway, Poland, South Africa, Sweden, and United Kingdom.

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This work was funded by AstraZeneca, Lund, Sweden.

Professor Lalloo was sponsored by AstraZeneca to present the data from this study at the European Respiratory Society meeting in Berlin 2001. Professor Thomson has received funding from AstraZeneca and GlaxoSmithKline to attend meetings of the American Thoracic Society, and funding from GlaxoSmithKline, AstraZeneca, and Merck for a member of staff to attend scientific meetings. Professor Thomson has also received research funds for clinical trials from AstraZeneca, GlaxoSmithKline, Novartis, and Merck.

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