Document Detail

Asthma control can be maintained after fixed-dose, budesonide/ formoterol combination inhaler therapy is stepped down from medium to low dose.
MedLine Citation:
PMID:  23093793     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In cases using a budesonide/formoterol combination inhaler, many patients are started on fixed-dose treatment at 640/18μg (4 puffs) daily, but there are no guidelines yet regarding the step-down method when control has been maintained.
METHODS: Patients with moderate asthma treated with either budesonide 400μg and salmeterol 100μg (GINA step3 group) or salmeterol/fluticasone 250 at 2 puffs (GINA step4 group) were enrolled and started on therapy of budesonide/formoterol 4 puffs. Thereafter, step-down to 2 puffs was performed if either of the following criteria was met at 8-week intervals: fractional exhaled nitric oxide (FeNO) ≤ 28 ppb plus asthma control test (ACT) score ≥ 22, or ACT score ≥ 24 at 3 consecutive visits regardless of FeNO level. Thereafter, changes in ACT score, the number of acute exacerbations and reliever use, and FeNO level were monitored through 48th week.
RESULTS: Fifty-one patients, 27 in step3 group and 24 in step4 group, underwent step-down. ACT scores and the number of reliever use remained stable in both groups even after step-down. In contrast, FeNO levels increased gradually in step4 group, whereas in the step3 group they increased immediately after step-down. Step-down was considered to be safely performed because the numbers of reliever use and those of moderate or more severe exacerbations during the 48-week period has not changed significantly compared to before step-down.
CONCLUSIONS: If complete control of asthma, not only of clinical symptoms but also airway inflammation, is achieved by 3-6 months of fixed-dose budesonide/formoterol 4 puffs/day, it should be possible to safely perform step-down to 2 puffs/day.
Masayuki Hojo; Tomonori Mizutani; Motoyasu Iikura; Satoshi Hirano; Nobuyuki Kobayashi; Haruhito Sugiyama
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-10-25
Journal Detail:
Title:  Allergology international : official journal of the Japanese Society of Allergology     Volume:  62     ISSN:  1440-1592     ISO Abbreviation:  Allergol Int     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-26     Completed Date:  2013-04-19     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  9616296     Medline TA:  Allergol Int     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  91-8     Citation Subset:  IM    
Division of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
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MeSH Terms
Administration, Inhalation
Adrenergic beta-2 Receptor Agonists / administration & dosage*
Aged, 80 and over
Anti-Inflammatory Agents / administration & dosage*
Asthma / drug therapy*
Budesonide / administration & dosage*
Drug Combinations
Ethanolamines / administration & dosage*
Middle Aged
Nebulizers and Vaporizers
Nitric Oxide / analysis
Risk Factors
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Adrenergic beta-2 Receptor Agonists; 0/Anti-Inflammatory Agents; 0/Drug Combinations; 0/Ethanolamines; 10102-43-9/Nitric Oxide; 51333-22-3/Budesonide; 5ZZ84GCW8B/formoterol

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