Routine Use of Budesonide/Formoterol Fixed Dose Combination in Elderly Asthmatic Patients: Practical Considerations
Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in older individuals, functional features and clinical presentations may be affected by age per se, and by age-related conditions, such as comorbidities and polypharmacy. In this review article, we aimed to explore the efficacy and safety in elderly asthmatic patients of one of the most currently used inhaled treatments for asthma, that is, the fixed-dose combination of budesonide/formoterol. We attempted to address some practical questions that are relevant to the daily practice of clinicians. We focused on the efficacy and real-world effectiveness of inhaled corticosteroids and long-acting β-adrenergic bronchodilators (ICS/LABA) as treatment in the elderly population, since data are extrapolated from younger populations. We investigated whether a maintenance and reliever therapy approach is more effective in the elderly as opposed to maintenance regimens, from both the general practitioner’s and the pulmonologist’s perspective. To address these questions, we scanned electronic databases (PubMed, MEDLINE, Embase, Scopus and Google Scholar) from the date of inception up to October 2016 with a cross-search using the following keywords: ‘asthma’, ‘elderly’, ‘SMART therapy’, ‘MART therapy’, ‘Turbuhaler’, and ‘budesonide/formoterol’. The available literature on the topic confirms that when the age-associated changes are properly managed in clinical practice, asthma in older populations can be optimally controlled with inhaled treatment including ICS/LABA. This also applies for the budesonide/formoterol fixed combination, thus allowing for the maintenance and reliever therapy approach.
KeywordsBudesonide Fluticasone Propionate Formoterol Mometasone Indacaterol
Compliance with Ethical Standards
Conflict of interest
Nicola Scichilone has received consulting fees or honoraria from Astra Zeneca, Boehringer Ingelheim, Chiesi, and Mundipharma outside of the submitted work, and support for travel for meetings from Roche. He reports payments for lectures from Astra Zeneca, Chiesi, and Novartis outside of the submitted work. Fulvio Braido has received consulting fees or honoraria from Menarini, Chiesi, Novartis, Astra Zeneca, Boehringer Ingelheim, Malesci/Guidotti, Zambon, Dompè, Biofutura, and GSK outside of the submitted work. Federico Lavorini has received consulting fees or honoraria from Chiesi, Menarini International, Cipla, TEVA, AstraZeneca, and Boehringer Ingelheim, and fees for participating in review activities from Chiesi, Cipla, TEVA, AstraZeneca, Boehringer Ingelheim, and Zentiva. Mark L. Levy has received fees for participating in review activities from DSMB Chiesi Pharmaceuticals, and lecture fees from Astra Zeneca, Chiesi, NAPP, and Teva outside of the submitted work. Omar S. Usmani has received grants from Astra Zeneca, Boehringer Ingelheim, Chiesi, Glaxo Smith Kline, and Edmond Pharma. He has also received consulting fees or honoraria from Boehringer Ingelheim, Chiesi, Cipla, Napp, Mundipharma, Sandoz, Takeda, and Zentiva outside of the submitted work. He reports payments for lectures from Aerocrine, Boehringer Ingelheim, Chiesi, Cipla, Mundipharma, Sandoz, and Takeda, outside of the submitted work.
No sources of funding were used to support the writing of this manuscript.
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