Combination corticosteroid/?-agonist inhaler as reliever therapy: A solution for intermittent and mild asthma? - 25/12/13
, Mark Weatherall, FRACP b, Philippa Shirtcliffe, FRACP a, Robert Hancox, MD c, Helen K. Reddel, PhD dAbstract |
The recommended treatment of mild asthma is regular maintenance inhaled corticosteroids (ICSs) with a short-acting β-agonist as a separate inhaler used when needed for symptom relief. However, the benefits of regular ICS use in actual clinical practice are limited by poor adherence and low prescription rates. An alternative strategy would be the symptom-driven (as-required or “prn”) use of a combination ICS/short-acting β-agonist or ICS/long-acting β-agonist inhaler as a reliever rather than regular maintenance use. The rationale for this approach is to titrate both the ICS and β-agonist dose according to need and enhance ICS use in otherwise poorly adherent patients who overrely on their reliever β-agonist inhaler. This strategy will only work if the β-agonist component has a rapid onset of action for symptom relief. There is evidence to suggest that this regimen has advantages over regular ICS therapy and might represent an effective, safe, and novel therapy for the treatment of intermittent and mild asthma. In this commentary we review this evidence and propose that randomized controlled trials investigating different combination ICS/β-agonist inhaler products prescribed according to this regimen in intermittent and mild asthma are an important priority.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, combination therapy, inhaled steroid, β-agonist
Abbreviations used : ICS, LABA, RCT, SABA, SMART
| Disclosure of potential conflict of interest: R. Beasley is a board member for the Health Research Council of New Zealand and GlaxoSmithKline; has received consultancy fees from Cytos Biotechnology and Pharmaxis; has received research support from AstraZeneca, Chiesi, Cephalon, GlaxoSmithKline, Genentech, Novartis, and the Health Research Council of New Zealand; has received lecture fees from GlaxoSmithKline, Novartis, and Otsuka; and has received travel support from Boehringer Ingelheim, Nycomed, and Novartis. R. Hancox has received lecture fees from GlaxoSmithKline and has received travel support from Boehringer Ingelheim. H. K. Reddel is a board member for AstraZeneca, GlaxoSmithKline, Merck, and Novartis; has received consultancy fees from AstraZeneca, Mundipharma, and Novartis; has received research support from GlaxoSmithKline and AstraZeneca; and has received payment for manuscript preparation from AstraZeneca, GlaxoSmithKline, and Novartis. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 133 - N° 1
P. 39-41 - janvier 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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