Asthma: rescue budesonide-formoterol tops maintenance budesonide+terbutaline

  • Hardy J & al.
  • Lancet
  • 23 Aug 2019

  • International Clinical Digest
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Takeaway

  • Budesonide-formoterol as-needed reliever therapy is associated with 31% fewer severe exacerbations per patient per year than maintenance budesonide plus as-needed terbutaline in primary care patients with mild to moderate asthma.

Why this matters

  • Many patients in primary care are poorly adherent with maintenance medication because of the intermittent nature of symptoms.
  • Formoterol is a fast-onset, long-acting β-adrenergic agonist.

Study design

  • 52-week, open-label, parallel-group, multicentre superiority randomised controlled trial (n=885) of as-needed budesonide 200 μg/formoterol 6 μg Turbuhaler or maintenance budesonide 200 μg Turbuhaler plus as-needed terbutaline 250 μg Turbuhaler for mild to moderate asthma.
  • Primary outcome was the number of severe exacerbations per patient per year in the intent-to-treat group; exacerbations were defined as systemic corticosteroid use for ≥3 days or admission to hospital or emergency department to receive systemic corticosteroids.
  • Funding: Health Research Council of New Zealand.

Key results

  • The budesonide-formoterol group had 31% fewer severe exacerbations per patient per year (0.119 vs 0.172 in the maintenance budesonide plus terbutaline group; relative rate 0.69; P=.049).
  • Groups had similar rates of the most common adverse event, nasopharyngitis (35% vs 32%, respectively).

Limitations

  • Open-label design.