Effects of inhaled formoterol and budesonide in reducing asthma exacerbations

Long-acting inhaled β2-agonists have recently become available to treat asthmatics. They are similar in efficacy to short-acting inhaled β2-agonists, but provide bronchodilation and bronchoprotection for more than 12 h. Two studies have suggested that the addition of a long-acting inhaled β2-agonist to low or moderate doses of inhaled glucocorticosteroids, in patients whose asthma is not ideally controlled on inhaled glucocorticosteroids alone, provides better symptom control and improved flow rates when compared to increasing the dose of the inhaled glucocorticosteroid. There has been concern, however, that the marked efficacy of the long-acting β2-agonists will mask the development of asthma exacerbations, or that when exacerbations occur, they will be more severe. A study to formally evaluate the number of mild and severe asthma exacerbations with the addition of the inhaled long-acting β2-agonist formoterol, to low or higher doses of inhaled glucocorticosterold (budesonide) has demonstrated the efficacy of this treatment. The addition of formoterol resulted in significant improvements in lung function and in a reduction in the total number of exacerbations. This study has clarified concerns about the addition of inhaled formoterol to budesonide, and has more firmly established the position of inhaled formoterol in asthma therapy.