Allergy 2013 May (2)-5


Pulm Pharamcol Ther 2013; 26: 189-194.

Matsunaga K, Kawabata H, Hirano T, Sugiura H, Minakata Y, Ichinose M.

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.


Combinations of inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABA) have become widely used for the initiation of maintenance treatment for asthma. However, it has not been fully elucidated whether ICS/LABA alters the time-course of control outcome measures in steroid-naive patients with asthma compared to the treatment with ICS alone. In this randomized, prospective, parallel group study, we investigated the differences in the time-course of improvement in asthma symptoms as reflected in the answers to an Asthma Control Questionnaire (ACQ), airflow limitation (FEV1), airway inflammation (FENO), and airway responsiveness to methacholine (PD200) between budesonide (BUD) and budesonide/formoterol (BUD/FM) in steroid-naive patients with asthma. Mean values of the ACQ score showed an improvement in a shorter period by BUD/FM therapy compared to BUD alone. A logistic function model showed that the BUD/FM combination significantly improved ACQ, FEV1, FENO and PD200 at a faster rate than BUD over 24 weeks (p < 0.001 for ACQ, FEV1, PD200, and p < 0.05 for FENO)(Supplemental figure). Over the whole study period, the percentage increase in FEV1 was significantly related to the PD200 improvement (r = 0.60, p < 0.001). Moreover, the degree of the reduction in FENO levels was also associated with that of the increase in the methacholine threshold (r = -0.50, p < 0.005). A significant variance in the time-response was also found in the outcomes of the two treatment groups (FENO and ACQ > FEV1 and PD200, p < 0.001). The present study provides evidence that ICS/LABA combination therapy results in a more rapid improvement in asthma symptoms, lung function, and airway inflammation compared to ICS monotherapy in steroid-naive patients with asthma. However, with combination drugs care must be taken not to discontinue the treatment early because of the dissociation between symptoms and lung function improvements.


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