Page 31 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 31
Despite these advances, the information and reduced exacerbations and the need for 31
on whether inhaled corticosteroids prevent rescue medications.63
deaths from asthma remained sparse and in- the story of corticosteroids in asthma
conclusive. Suissa S. and coworkers conduct- During the first decade of 21st century,
ed a population-based epidemiologic study to effort was made to achieve control of asth-
determine whether and to what extent the use ma symptoms and exacerbations with the
of inhaled corticosteroids prevents death from use of ICS and LABA combinations. In the
asthma. The cohort consisted of 30596 sub- Gaining Optimal Asthma Control (GOAL)
jects who were followed from 1975 through study, Bateman and colleagues have assessed
1997 and the results were published in 2000. how frequently total asthma control or well
Authors concluded that regular use of low controlled asthma control can be achieved.
dose inhaled corticosteroids was associat- Stepping up the treatment to higher doses of
ed with a decreased risk of death from asth- Fluticasone alone or Fluticasone/Salmeter-
ma and that the rate of death from asthma ol resulted in a higher proportion of patients
decreased by 21 percent with each addition- with controlled asthma. Similarly to the FAC-
al canister of inhaled corticosteroids used in ET study, more patients rapidly achieved to-
the previous year.61 Unfortunately, to this day, tally or well-controlled asthma with the com-
we see patients receiving bronchodilators only bination of inhaled salmeterol/fluticasone
and deaths associated with excessive broncho- and at a lower dose of corticosteroid than
dilator use. with inhaled fluticasone alone.64 Another op-
tion for gaining asthma control was the use
Enhancing Efficacy of ICS with LABA: of fixed Budesonide/Formoterol combination
Past and Present both for maintenance and relief, the Sym-
bicort Maintenance And Reliever Therapy
A major advance in asthma management (SMART) approach. In 2007 Bousquet J and
was also the discovery that LABAs enhance colleagues showed that in the treatment of
the clinical efficacy of inhaled corticosteroids uncontrolled asthma, budesonide/formoterol
in asthma62. In 1997 Pauwels R A and cow- maintenance and reliever therapy reduced the
incidence of severe asthma exacerbations and
orkers in the game-changing FACET study, hospitalization/ER treatment with similar
evaluated the effects of adding inhaled for- daily symptom control compared to sustained
moterol to both lower and higher doses of high-dose salmeterol/fluticasone plus SABA.
the inhaled glucocorticoid budesonide and This benefit war achieved with substantially
showed that combining ICS and LABAs, re- less ICS exposure.65 Over the following years
sulted in better outcomes, required lower dos- several studies supported the MART strategy
es of ICS and resulted in better lung function, in asthma treatment.
less activity limitation and better quality of
life. In short, 852 patients treated with glu- Over the last 20 years the combination
cocorticoids were randomly assigned to one of LABA with ICS remained the main op-
of four treatments (low or high ICS with or tion for the treatment of moderate to severe
without LABA) given twice daily for one asthma.66 On the contrary, guidelines recom-
year. The study showed that, in patients who mended, until recently, that most adults and
have persistent symptoms of asthma despite adolescents with mild asthma use regular dai-
treatment with inhaled glucocorticoids, the ly low dose ICS as maintenance treatment to
addition of formoterol to either the lower or reduce airway inflammation, symptoms, and
the higher dose of budesonide also improved the risk of exacerbations.67 However, in clin-
asthma-symptom scores and lung function ical practice patients show poor adherence
to asthma medications, particularly inhaled
on whether inhaled corticosteroids prevent rescue medications.63
deaths from asthma remained sparse and in- the story of corticosteroids in asthma
conclusive. Suissa S. and coworkers conduct- During the first decade of 21st century,
ed a population-based epidemiologic study to effort was made to achieve control of asth-
determine whether and to what extent the use ma symptoms and exacerbations with the
of inhaled corticosteroids prevents death from use of ICS and LABA combinations. In the
asthma. The cohort consisted of 30596 sub- Gaining Optimal Asthma Control (GOAL)
jects who were followed from 1975 through study, Bateman and colleagues have assessed
1997 and the results were published in 2000. how frequently total asthma control or well
Authors concluded that regular use of low controlled asthma control can be achieved.
dose inhaled corticosteroids was associat- Stepping up the treatment to higher doses of
ed with a decreased risk of death from asth- Fluticasone alone or Fluticasone/Salmeter-
ma and that the rate of death from asthma ol resulted in a higher proportion of patients
decreased by 21 percent with each addition- with controlled asthma. Similarly to the FAC-
al canister of inhaled corticosteroids used in ET study, more patients rapidly achieved to-
the previous year.61 Unfortunately, to this day, tally or well-controlled asthma with the com-
we see patients receiving bronchodilators only bination of inhaled salmeterol/fluticasone
and deaths associated with excessive broncho- and at a lower dose of corticosteroid than
dilator use. with inhaled fluticasone alone.64 Another op-
tion for gaining asthma control was the use
Enhancing Efficacy of ICS with LABA: of fixed Budesonide/Formoterol combination
Past and Present both for maintenance and relief, the Sym-
bicort Maintenance And Reliever Therapy
A major advance in asthma management (SMART) approach. In 2007 Bousquet J and
was also the discovery that LABAs enhance colleagues showed that in the treatment of
the clinical efficacy of inhaled corticosteroids uncontrolled asthma, budesonide/formoterol
in asthma62. In 1997 Pauwels R A and cow- maintenance and reliever therapy reduced the
incidence of severe asthma exacerbations and
orkers in the game-changing FACET study, hospitalization/ER treatment with similar
evaluated the effects of adding inhaled for- daily symptom control compared to sustained
moterol to both lower and higher doses of high-dose salmeterol/fluticasone plus SABA.
the inhaled glucocorticoid budesonide and This benefit war achieved with substantially
showed that combining ICS and LABAs, re- less ICS exposure.65 Over the following years
sulted in better outcomes, required lower dos- several studies supported the MART strategy
es of ICS and resulted in better lung function, in asthma treatment.
less activity limitation and better quality of
life. In short, 852 patients treated with glu- Over the last 20 years the combination
cocorticoids were randomly assigned to one of LABA with ICS remained the main op-
of four treatments (low or high ICS with or tion for the treatment of moderate to severe
without LABA) given twice daily for one asthma.66 On the contrary, guidelines recom-
year. The study showed that, in patients who mended, until recently, that most adults and
have persistent symptoms of asthma despite adolescents with mild asthma use regular dai-
treatment with inhaled glucocorticoids, the ly low dose ICS as maintenance treatment to
addition of formoterol to either the lower or reduce airway inflammation, symptoms, and
the higher dose of budesonide also improved the risk of exacerbations.67 However, in clin-
asthma-symptom scores and lung function ical practice patients show poor adherence
to asthma medications, particularly inhaled
