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Inhaled Glucocorticosteroid and Long-Acting β2-Adrenoceptor Agonist Single-Inhaler Combination for Both Maintenance and Rescue Therapy

A Paradigm Shift in Asthma Management

  • Current Opinion
  • Published:
Treatments in Respiratory Medicine

Abstract

Despite aggressive fixed-dose (FD) combination therapy with inhaled glucocorticosteroids (ICS) and long acting β2-adrenoceptor agonists (LABA), many patients with asthma remain suboptimally controlled, based on the need for rescue therapy and rates of severe exacerbations. The strategy of adjustable maintenance dosing (AMD) involves adjustment of the maintenance dose, (using a single combination [budesonide/formoterol] inhaler, Symbicort®) in response to variability of asthma control over time. The AMD strategy, like the FD approach, involves the use of a short-acting β2-adrenoceptor agonist (SABA) for rapid relief of bronchospasm. The dose-response characteristics of budesonide/formoterol make the AMD strategy a feasible option that cannot be exploited with the combination of salmeterol/fluticasone propionate (Advair®). Several studies suggest that the AMD strategy is superior to a FD approach in terms of overall asthma control.

Budesonide/formoterol in a single inhaler is as effective as albuterol (salbutamol) for relief of acute asthma episodes, a feature that makes it possible to use this combination for both maintenance and reliever therapy without the need for the use of a SABA. The single-inhaler strategy has been shown to be safe and more efficacious than FD therapy. In particular, the COSMOS study has demonstrated that exacerbation burden is reduced more effectively when the combination (budesonide/formoterol) single inhaler is used for both maintenance and relief compared with FD therapy with salmeterol/fluticasone and albuterol for rescue in patients with moderate-to-severe asthma. These findings suggest that we will have to reconsider our definition of reliever therapy for patients that require long-term therapy with combination ICS and LABA.

The concept of single-inhaler therapy represents a paradigm shift in asthma management that has been validated in several large studies involving thousands of patients. The single-inhaler strategy represents one of the most significant advances in asthma management in many years, and one that appears ideal for adoption in primary care.

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Notes

  1. 1 The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgments

I would like to acknowledge Deborah K. D’Urzo for her assistance in preparing the manuscript. No sources of funding were used to assist in the preparation of this article, and the author has no conflicts of interest that are directly relevant to the content.

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  1. Department of Family and Community Medicine, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada

    Anthony D. D’Urzo

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Correspondence to Anthony D. D’Urzo.

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D’Urzo, A.D. Inhaled Glucocorticosteroid and Long-Acting β2-Adrenoceptor Agonist Single-Inhaler Combination for Both Maintenance and Rescue Therapy. Treat Respir Med 5, 385–391 (2006). https://doi.org/10.2165/00151829-200605060-00003

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