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Communications to the Editor |

Formoterol and Asthma Exacerbations FREE TO VIEW

Thys van der Molen, MD
Author and Funding Information

University of Groningen Groningen, the Netherlands

Correspondence to: Thys van der Molen, MD, Department of General Practice, University of Groningen, Bloemsingel 1, Groningen 9713 BZ, the Netherlands; e-mail: t.van.der.molen@med. rug.nl



Chest. 2004;125(4):1591. doi:10.1378/chest.125.4.1591-a
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Published online

To the Editor:

The paper by Mann et al (July 2003)1concludes that treatment with formoterol, 24 μg bid, in patients with asthma may lead to more serious asthma exacerbations as compared to placebo. The authors based their conclusion on three studies in which 24 μg of formoterol bid was compared with placebo, from which one study was performed in children. The number of serious exacerbations in these studies was slightly higher for formoterol but not statistically different between groups. We performed a 6-month study2with inhaled formoterol, 24 μg bid, in 239 adult patients with moderate asthma, showing contrasting results. We found a similar incidence of exacerbations as measured by the number of prednisolone courses: 26.4% of patients receiving formoterol needed at least one prednisolone course and 28.1% receiving placebo. Moreover, the number of patients who discontinued the study because of deterioration of asthma was higher in the placebo group (n = 6) than in the formoterol group (n = 1). Our patients continued their previously prescribed inhaled corticosteroids throughout this double-blind study. The finding that formoterol reduces and not increases the number of asthma exacerbations is consistent with studies34 that were designed to measure the effect of lower dosages of formoterol on exacerbations in moderate asthma. Our study showed that a higher dose of formoterol in conjunction with inhaled corticosteroids is also safe and will not lead to extra concern. Though Mann et al1 stated that patients of the three studies presented were allowed to continue their steroids, the article did not reveal whether the patients with the reported serious exacerbations received inhaled corticosteroids. This might be a more important explanation for the number of serious exacerbations than the difference in formoterol dosage between the studies cited by Mann et al1 and other studies.

References

Mann, M, Chowdhury, B, Sullivan, E, et al (2003) Serious asthma exacerbations in asthmatics treated with high-dose formoterol.Chest124,70-74
 
Van der Molen, T, Postma, DS, Turner, MO, et al Effects of the long acting β agonist formoterol on asthma control in asthmatic patients using inhaled corticosteroids.Thorax1997;52,525-539
 
Pauwels, RA, Löfdahl, C-G, Postma, DS, et al Effect of inhaled formoterol and budesonide on exacerbations of asthma.N Eng J Med1997;337,1405-1411
 
O’Byrne, PM, Barnes, PJ, Rodriguez-Roisin, R, et al Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial.Am J Respir Crit Care Med2001;164,1392-1397
 

Figures

Tables

References

Mann, M, Chowdhury, B, Sullivan, E, et al (2003) Serious asthma exacerbations in asthmatics treated with high-dose formoterol.Chest124,70-74
 
Van der Molen, T, Postma, DS, Turner, MO, et al Effects of the long acting β agonist formoterol on asthma control in asthmatic patients using inhaled corticosteroids.Thorax1997;52,525-539
 
Pauwels, RA, Löfdahl, C-G, Postma, DS, et al Effect of inhaled formoterol and budesonide on exacerbations of asthma.N Eng J Med1997;337,1405-1411
 
O’Byrne, PM, Barnes, PJ, Rodriguez-Roisin, R, et al Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial.Am J Respir Crit Care Med2001;164,1392-1397
 
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