Effects of inhaled corticosteroids/long-acting beta-2 agonist fix combinations in COPD

Abstract Background The treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues. Instead, the current Global Initiative for Asthma (GINA) Report recommends the use of the combination of inhaled corticosteroids (ICS) with the rapid/long-acting beta-2 agonist formoterol, although the use in steps 1 and 2 is still off-label in the EU and in many countries. It is important to understand clinicians’ knowledge and opinions on the issue with the ultimate goal to encourage the implementation of the new approach in clinical practice. Methods We performed an international survey, directed to pulmonologists interested in the management of patients with asthma. Results Most participants reported that SABA alone should not be used in GINA Step 1 asthma treatment. As-needed low-dose ICS/formoterol combination to patients in step 1, and as-needed low-dose ICS/formoterol as reliever therapy in any step were found to be of current use prescribed in their real-life settings. SABA alone was still prescribed to a proportion of patients, although the pulmonologists’ opinion was that it should no longer be used. Conclusions Most specialists are up to date and understand the relevance of the changes in GINA reports from 2019. Nevertheless, dissemination and implementation of GINA novel management strategy is still needed.

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Comparing the Asthma Control and Anti-inflammatory Effects of Different Fixed Combinations of Inhaled Corticosteroids Plus Long-acting Beta 2 Agonist; A Randomized Clinical Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6548 ◽

2021 ◽

Vol 9 (B) ◽

pp. 771-778

Author(s):

Ashraf Elsayed Sileem ◽

Ahmed Ali ◽

Hanan Elnahas ◽

Ahmed M. Gouda

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Asthma Control ◽

Severe Asthma ◽

Inhaled Corticosteroids ◽

Treated Group ◽

Fixed Dose ◽

Beta 2 ◽

Hs Crp ◽

Long Acting

Background: Asthma is the most common chronic inflammatory disease of the pulmonary system. The prevalence of asthma is growing enormously worldwide posing a significant health and economic burden. Asthma treatment guidelines recommend a combination of inhaled corticosteroid (ICS) and long-acting beta 2 agonist (LABA). However, there is little guidance for clinicians on selecting a specific ICS/LABA combination. Aim: To compare the effectiveness of three fixed dose ICS/LABA combination therapies i.e., fluticasone/salmeterol, fluticasone/formoterol and budesonide/formoterol for the management of moderate to severe asthma. Design: This was a prospective interventional, three-armed, parallel group, open label, and randomized clinical trial Methods: Adult asthmatic patients of both genders (n=135) were randomly allocated to the three ICS/LABA treatment groups: fluticasone/salmeterol-treated group (n=45) , fluticasone/formoterol-treated group (n=45) and budesonide/formoterol-treated group (n=45). All groups were treated for three months. The main outcome parameters included lung function (FEV1, FEV1%, FEV1/FVC), inflammatory state (hs-CRP, ECP) and asthma control (ACT). Results: After 3 months of treatment, fluticasone/formoterol significantly increased FEV1 compared to fluticasone/salmeterol (p<0.01) and FEV1% compared to budesonide/formoterol (p<0.01). Both fluticasone-containing combinations significantly increased FEV1/FVC (p<0.001, p<0.001), decreased serum hs-CRP (p<0.01, p<0.001), and serum ECP (p<0.05, p<0.001) and improved ACT (p<0.05, p<0.01) compared to budesonide. Fluticasone/formoterol significantly reduced ECP in comparison to fluticasone/salmeterol (p<0.05). Conclusion: Our study showed a superiority for fluticasone-containing combinations over budesonide for the treatment of moderate to severe asthma. Within the former combinations, fluticasone/formoterol was better than fluticasone/salmeterol.

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