Switching from salmeterol/fluticasone to formoterol/budesonide combinations improves peripheral airway/alveolar inflammation in asthma.

Abstract

BACKGROUND:

Combination therapy with an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) in a single inhaler is the mainstay of asthma management. We previously showed that switching from salmeterol/fluticasone combination (SFC) 50/250 μg bid to a fixed-dose formoterol/budesonide combination (FBC) 9/320 μg bid improved asthma control and pulmonary functions, but not fractional exhaled nitric oxide (FeNO), in patients with asthma not adequately controlled under the former treatment regimen.

OBJECTIVE:

To assess whether switching from SFC to FBC improves peripheral airway/alveolar inflammation in asthma (UMIN000009619).

METHODS:

Subjects included 66 patients with mild to moderate asthma receiving SFC 50/250 μg bid for more than 8 weeks. Patients were randomized into FBC 9/320 μg bid or continued the same dose of SFC for 12 weeks. Asthma Control Questionnaire, 5-item version (ACQ5) score, peak expiratory flow, spirometry, FeNO, alveolar NO concentration (CANO), and maximal NO flux in the conductive airways (J'awNO) were measured.

RESULTS:

Sixty-one patients completed the study. The proportion of patients with an improvement in ACQ5 was significantly higher in the FBC group than in the SFC group (51.6% vs 16.7%, respectively, p = 0.003). A significant decrease in CANO was observed in the FBC group (from 8.8 ± 9.2 ppb to 4.0 ± 2.6 ppb; p = 0.007) compared to the SFC group (from 7.4 ± 7.8 ppb to 6.4 ± 5.0 ppb; p = 0.266) although there was no significant difference in the changes in pulmonary functions between the 2 groups. Similar significant differences were found in the CANO corrected for the axial back diffusion of NO (FBC, from 6.5 ± 8.2 ppb to 2.3 ± 2.5 ppb; and SFC, from 4.3 ± 5.3 ppb to 3.9 ± 4.3 ppb). There was no difference in the changes in FeNO or J'awNO between the 2 groups.

CONCLUSIONS:

Switching therapy from SFC to FBC improves asthma control and peripheral airway/alveolar inflammation even though there is no improvement in pulmonary functions, and FeNO in asthmatic patients.

• Authors: Taisuke Akamatsu, Toshihiro Shirai, Masato Kato, Hideki Yasui, Dai Hashimoto, Tomoyuki Fujisawa, Tomoyoshi Tsuchiya, Naoki Inui, Takafumi Suda, Kingo Chida
• Journal: Pulmonary pharmacology & therapeutics (Pulm Pharmacol Ther) Vol. 27 Issue 1 Pg. 52-6 (Feb 2014) ISSN: 1522-9629 [Electronic] England
• PMID: 23583566 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Adrenergic beta-2 Receptor Agonists
• Androstadienes
• Bronchodilator Agents
• Drug Combinations
• Ethanolamines
• Fluticasone-Salmeterol Drug Combination
• Nitric Oxide
• Budesonide
• Albuterol
• Formoterol Fumarate

Topics

• Administration, Inhalation
• Adrenergic beta-2 Receptor Agonists (administration & dosage, therapeutic use)
• Adult
• Aged
• Albuterol (administration & dosage, analogs & derivatives, therapeutic use)
• Androstadienes (administration & dosage, therapeutic use)
• Asthma (drug therapy, physiopathology)
• Bronchodilator Agents (administration & dosage, therapeutic use)
• Budesonide (administration & dosage, therapeutic use)
• Drug Combinations
• Ethanolamines (administration & dosage, pharmacology)
• Female
• Fluticasone-Salmeterol Drug Combination
• Formoterol Fumarate
• Humans
• Inflammation (drug therapy, pathology)
• Male
• Middle Aged
• Nitric Oxide (metabolism)
• Prospective Studies
• Pulmonary Alveoli (pathology)
• Severity of Illness Index
• Spirometry
• Surveys and Questionnaires
• Treatment Outcome