The objective of this study was to compare the efficacy and safety of the second controller medications (long-acting beta2-agonist,
leukotriene receptor antagonist and sustained-release
theophylline) used in addition to
inhaler corticosteroid treatment in moderate persistent
asthma. A total of 64 patients with
asthma, in the moderate persistent
asthma category, were divided into three groups. Patients, all of whom were concurrently using inhaled
corticosteroid (
Budesonide 400 microg twice daily), were treated for 3 months with either inhaled
formoterol 9 microg twice daily (first group), oral
zafirlukast 20 mg twice daily (second group), or sustained-release
theophylline 400 mg once daily (third group). All of the patients were subjected to assessments on the subject of peak expiratory flow (PEF) variability, forced expiratory volume in 1 sec (FEV1),
asthma symptom scores (daytime and night-time), supplemental terbutalin use,
asthma exacerbations and adverse events. Over the 3-month treatment period. In all of the three groups, significant improvements were recorded in the lung function,
asthma symptom scores and supplemental terbutalin use criteria, as a result oftreatments applied.
Formoterol treatment resulted in significantly greater and earlier improvements compared with the other two groups in several criteria: PEF variability (17.9 +/- 2.5; 21.9 +/- 3.2; 23.7 +/- 3.3; P < 0.001);
asthma symptom score (daytime) (1.6 +/- 0.5; 1 +/- 0.5; 2.0 +/- 0,5; P < 0.05);
asthma symptom score (night-time) (1.2 +/- 0.4; 2.2 +/- 0.5; 16 +/- 0.6; P < 0001); and supplement alter butalin use (1.2 +/- 0.3; 1.8 +/- 0.5; 1.7 +/- 0.5; P < 0.05). However, at the end of the treatment, in all of the three groups studied, improvements were attained in overall
asthma control and there was no statistical difference among the groups. Although there were no side effects which required the discontinuation of the treatment, it was observed that the maximum side effect was in the second group (20%, 31.6% and 20%, respectively). In conclusion, in patients who still have symptoms on treatment with inhaled
corticosteroids, the addition of a long-acting beta2-agonist,
leukotriene antagonists or sustained-release
theophylline to the treatment is a logical approach, and, in addition to inhaled
corticosteroids, any one of these second controller medications may be chosen in patients with moderate
asthma.