Current
asthma management guidelines state that where a patient is receiving a low to moderate dose of inhaled
corticosteroids and is still experiencing symptoms the dose of
corticosteroid should be increased and, if necessary, a long-acting
bronchodilator should be added. Many studies have now shown that the addition of a beta2-agonist with long-acting properties is more effective at controlling
asthma symptoms than increasing the dose of
corticosteroid alone. The
Formoterol and
Corticosteroid Establishing
Therapy (FACET) study was a 12-month study comparing exacerbation rates in patients treated with
budesonide (100 microg or 400 microg) twice daily alone vs, treatment with
budesonide (100 microg or 400 microg) twice daily plus
formoterol 9 microg twice daily (delivered dose). The addition of
formoterol reduced the rates of mild and severe exacerbations compared with
budesonide alone, with the lowest rates seen in patients receiving high-dose
budesonide and
formoterol. There was no difference in the profile of exacerbations in any groups, indicating
formoterol does not mask any signs of
inflammation. The addition of
formoterol to
budesonide was also shown to result in improved lung function (as measured by peak expiratory flow rate and forced expiratory volume in 1 second), night-time awakenings and the use of as-needed medication when compared with an increase in the dose of
budesonide. In all cases, increasing the dose of
budesonide and addition of
formoterol resulted in the most improvement and a significant increase in quality of life, measured by
Asthma Quality of Life Questionnaire (AQLQ), was noted. In conclusion, the addition of
formoterol to established treatment with inhaled
corticosteroids provides superior
asthma control compared with an increase in the dose of
corticosteroid alone.