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Increasing doses of inhaled corticosteroids compared to adding long-acting inhaled β₂-agonists in achieving asthma control.

¹Department of Medicine, McMaster University, Hamilton, Ontario, Canada ²AstraZeneca R&D, Lund, Sweden ³Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ⁴National Heart and Lung Institute, Imperial College, London, UK

obyrnep{at}mcmaster.ca

Abstract

BackgroundCombination therapy with inhaled corticosteroids (ICS) and long-acting β₂-agonists (LABA), or treatment with high doses of ICS alone, improves asthma control when low-dose ICS is not sufficient. However, it is not known which of these treatment options is more effective in sustaining asthma control.

ObjectivesTo evaluate the effect of increasing ICS versus adding LABA on time spent with well-controlled asthma or poorly controlled asthma.

MethodsPost hoc analysis of the Formoterol and Corticosteroid Establishing Therapy (FACET) study, which compared a four-fold increase in budesonide dose with and without formoterol.

ResultsTime with well-controlled asthma was improved by 19% (95% CI: 3–35%, p=0.017) by adding formoterol 24 µg.d^–1 to budesonide 200 µg.d^–1 compared to 2% (95% CI: –9–12%, p=0.76) with budesonide 800 µg.d^–1 alone. Time with well-controlled asthma was further improved by 29% (95% CI: 13–47%, p<0.001) by adding formoterol to budesonide 800 µg d^–1. Time with poorly controlled asthma was significantly reduced by the same interventions by 43% (95% CI: 25–57%), 22% (95% CI: 7–44%) and 50% (95% CI: 30–64%) respectively. Adding formoterol to budesonide was significantly more effective in increasing time with well-controlled asthma when compared to increasing the budesonide dose 4-fold (increase 16%: CI: 1–33%, p=0.035), with a trend for a greater reduction in time with poor control (decrease 21%; 95% CI: -5– 42%).

ConclusionThe addition of formoterol to low dose budesonide increases the probability of well-controlled asthma compared to a substantial increase in the dose of ICS.

Key Words: Asthma control • Long-acting beta₂-agonists (LABA) • Budesonide • Inhaled corticosteroids • Formoterol