New Versus Old: The Impact of Changing Patterns of Inhaled Corticosteroid Prescribing and Dosing Regimens in Asthma Management.

Abstract

Inhaled corticosteroid (ICS)-containing therapies are the mainstay of pharmacological management of asthma. They can be administered alone or in combination with a long-acting bronchodilator, depending on asthma severity, and may also be supplemented with short-acting bronchodilators for as-needed rescue medication. Adherence to asthma therapies is generally poor and characterized by underuse of ICS therapies and over-reliance on short-acting bronchodilators, which leads to poor clinical outcomes. This article reviews efficacy versus systemic activity profiles for various dosing regimens of budesonide (BUD) and fluticasone propionate (FP). We performed a structured literature review of BUD and FP regular daily dosing, and BUD/formoterol (FOR) as-needed dosing, to explore the relationship between various dosing patterns of ICS regimens and the risk-benefit profile in terms of the extent of bronchoprotection and cortisol suppression. In addition, we explored how adherence could potentially affect the risk-benefit profile, in patients with mild, moderate, and moderate-to-severe asthma. With a specific focus on BUD or FP-containing treatments, we found that regular daily ICS and ICS/long-acting β2-agonist (LABA) dosing had a greater degree of bronchoprotection than as-needed BUD/FOR dosing or BUD/FOR maintenance and reliever therapy (MART) dosing, and still maintained low systemic activity. We also found that the benefits of regular daily ICS dosing regimens were diminished when adherence was low (50%); the shorter duration of bronchoprotection observed was similar to that seen with typical as-needed BUD/FOR usage. These findings have implications for aiding clinicians with selecting the most suitable treatment option for asthma management, and subsequent implications for the advice clinicians give their patients.

• Authors: Dave Singh, Gabriel Garcia, Kittipong Maneechotesuwan, Peter Daley-Yates, Elvis Irusen, Bhumika Aggarwal, Isabelle Boucot, Norbert Berend
• Journal: Advances in therapy (Adv Ther) Vol. 39 Issue 5 Pg. 1895-1914 (05 2022) ISSN: 1865-8652 [Electronic] United States
• PMID: 35284999 (Publication Type: Journal Article, Review, Research Support, Non-U.S. Gov't)
• Copyright: © 2022. The Author(s).

Chemical References

• Adrenal Cortex Hormones
• Anti-Asthmatic Agents
• Bronchodilator Agents
• Budesonide, Formoterol Fumarate Drug Combination
• Drug Combinations
• Ethanolamines
• Budesonide
• Fluticasone
• Formoterol Fumarate

Topics

• Administration, Inhalation
• Adrenal Cortex Hormones (therapeutic use)
• Anti-Asthmatic Agents (therapeutic use)
• Asthma (drug therapy)
• Bronchodilator Agents (therapeutic use)
• Budesonide (therapeutic use)
• Budesonide, Formoterol Fumarate Drug Combination (therapeutic use)
• Drug Combinations
• Ethanolamines (therapeutic use)
• Fluticasone (therapeutic use)
• Formoterol Fumarate (therapeutic use)
• Humans