Step-down of budesonide/formoterol in early stages of asthma treatment leads to insufficient anti-inflammatory effect. (17th June 2013)

• Record Type: Journal Article
• Authors: Obase, Yasushi; Ikeda, Masaki; Kurose, Koji; Abe, Masaaki; Shimizu, Hiroki; Ohue, Yoshihiro; Mouri, Keiji; Katoh, Shigeki; Kobashi, Yoshihiro; Oka, Mikio
• Is Part Of: Journal of asthma. Volume 50:Number 7(2013)
• Page Start: 718
• Page End: 721
• Publication Date: 2013-06-17
• Subjects: Asthma control test -- asthma control questionnaire -- asthma quality of life questionnaire -- budesonide/formoterol -- fractional exhaled nitric oxide -- step-down -- symbicort; Asthma -- Periodicals; 616.238005
• DOI: 10.3109/02770903.2013.795588
• Languages: English
• ISSNs: 0277-0903

Abstract

Abstract: Objective : Administration of the combination of an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is the main treatment strategy for bronchial asthma. The ICS/LABA dosage can be reduced (stepped down) when the patient's symptoms and lung functions are well-controlled. In this study, we obtained fractional exhaled nitric oxide (FeNO) measurements to clarify whether the anti-inflammatory effect of budesonide/formoterol is shortened by step-down. Methods : Fifty-four patients who visited the Kawasaki Medical School Hospital with newly diagnosed asthma from November 2008 to July 2010 received budesonide/formoterol for 8 weeks or more. In 29 patients, the forced expiratory volume in 1 s% predicted increased to 80% or more, and the Asthma Control Questionnaire (ACQ) score decreased to 0.5 or less within 12 weeks. These 29 patients were randomly divided into two groups: the dosage-continued group ( n = 14) and the step-down group ( n = 15). Then, the impact of budesonide/formoterol step-down on ACQ score, pulmonary function and FeNO level was compared between the groups. Results : In the step-down group, the dosage was stepped down from 538 mcg/day to 331 mcg/day. In both groups, pulmonary function indicators and symptoms did not change. However, the mean FeNO level decreased significantly in the dosage-continued group (from 50.9 ppb to 45.0 ppb), and increased significantly in the step-down group (from 51.0 ppb to 65.7 ppb). Conclusions : Clinicians should be more careful when stepping down budesonide/formoterol based solely on patients' symptoms and/or pulmonary function.