Effect of formoterol with or without budesonide in repeated low-dose allergen challenge.

Abstract

The use of combination therapy in mild asthma is debated. The current authors evaluated the effects of formoterol alone and a formoterol/budesonide combination inhaler on asthma deterioration induced by repeated low-dose allergen exposure. In total, 15 subjects with intermittent allergic asthma inhaled low doses of allergen on seven consecutive weekdays in a three-period, crossover, double-blind, double-dummy comparison between formoterol 4.5 microg Turbuhaler, budesonide 160 microg/formoterol 4.5 microg Turbuhaler and placebo, each taken as two puffs 30 min after allergen dosing. The outcome variables were: provocative dose of methacholine causing a 20% fall in forced expiratory volume in one second (PD(20)), exhaled nitric oxide fraction (F(eNO)), sputum eosinophils and prostaglandin D(2), and diary card recordings of symptoms (on a scale of 0-10), short-acting beta(2)-agonist use and evening forced expiratory volume in one second (FEV(1)). With placebo treatment, allergen exposure caused significant increases in airway hyperresponsiveness (geometric mean (coefficient of variation) PD(20): 397 (98) microg before versus 168 (82) microg after), F(eNO) (mean+/-sd 46+/-31 ppb before versus 73+/-46 ppb after) and asthma symptom score (mean+/-sd 0.39+/-0.55 before versus 0.68+/-0.67 after). Budesonide/formoterol abolished these changes and significantly improved baseline FEV(1). Formoterol alone, while providing symptom relief, was no better than placebo in protecting against the allergen-induced increase in airway inflammation. Signs of deteriorating asthma, provoked by low-dose allergen, are prevented by short-term use of budesonide/formoterol but not by temporary use of formoterol alone.

• Authors: B Dahlén, A-S Lantz, E Ihre, M Skedinger, E Henriksson, L Jörgensen, T Ekström, S-E Dahlén, K Larsson
• Journal: The European respiratory journal (Eur Respir J) Vol. 33 Issue 4 Pg. 747-53 (Apr 2009) ISSN: 1399-3003 [Electronic] England
• PMID: 19129280 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Bronchodilator Agents
• Ethanolamines
• Budesonide
• Formoterol Fumarate

Topics

• Administration, Inhalation
• Adult
• Analysis of Variance
• Asthma (drug therapy, physiopathology)
• Bronchial Provocation Tests
• Bronchodilator Agents (administration & dosage, therapeutic use)
• Budesonide (administration & dosage, therapeutic use)
• Cross-Over Studies
• Double-Blind Method
• Drug Therapy, Combination
• Ethanolamines (administration & dosage, therapeutic use)
• Female
• Formoterol Fumarate
• Humans
• Least-Squares Analysis
• Male
• Middle Aged
• Respiratory Function Tests
• Sputum (cytology)
• Treatment Outcome