Using a combination inhaler (budesonide plus formoterol) as rescue therapy improves asthma control

doi:10.1136/bmj.39273.537778.AD

BMJ 2007;335:513 (8 September), doi:10.1136/bmj.39273.537778.AD

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Using a combination inhaler (budesonide plus formoterol) as rescue therapy improves asthma control

Peter J Barnes, professor of thoracic medicine

National Heart and Lung Institute, Imperial College, London

P J Barnes, Airway Disease Section, National Heart and Lung Institute, Dovehouse St, London SW3 6LY p.j.barnes@imperial.ac.uk

The first 150 words of the full text of this article appear below.

The clinical problem

Asthma is one of the commonest chronic diseases worldwide andis effectively controlled in most patients with maintenancetreatment. In those with moderate or severe persistent asthma,control may be achieved with an inhaled corticosteroid or acombination inhaler containing a corticosteroid and a long acting $beta$ ₂agonist. The combination inhaler is more effective, but patientsstill require short acting $beta$ ₂agonists such as salbutamol orterbutaline to relieve symptoms. I describe a new approach foracute exacerbation—SMART (single inhaler maintenance andreliever therapy). This uses the combination inhaler, ratherthan the short acting $beta$ ₂agonist, as the reliever.

The evidence for change

Using a formulation of budesonide plus formoterol (budesonide/formoterol)both as a reliever and as maintenance therapy once or twicedaily is more effective in controlling asthma than conventionalapproaches using budesonide/formoterol, fluticasone/salmeterol,or high dose corticosteroids (budesonide or fluticasone) asthe maintenance treatment with short acting $beta$ ₂agonists as relievers(table

).¹ ² ³ ⁴ ⁵ The most striking . . . [Full text of this article]

Barriers to change

How should we change our practice?

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This article has been cited by other articles:

Papi, A., Caramori, G., Adcock, I. M., Barnes, P. J. (2009). Rescue Treatment in Asthma: More Than As-Needed Bronchodilation. Chest 135: 1628-1633 [Abstract] [Full text]
Levy, M. L. (2008). Guideline-defined asthma control: a challenge for primary care. Eur Respir J 31: 229-231 [Full text]
Hussain, S. F (2007). Way forward is not obvious at asthma crossroads. BMJ 335: 577-577 [Full text]

Rapid Responses:

Read all Rapid Responses

Using a combination inhaler (budesonide plus formoterol) as rescue therapy improves asthma control: Syed F Hussain
bmj.com, 7 Sep 2007 [Full text]
A SMART choice for primary care asthma therapy ?: Brian J Lipworth, et al.
bmj.com, 13 Oct 2007 [Full text]