0
Original Research: ASTHMA |

Budesonide/Formoterol Maintenance Plus Reliever Therapy*: A New Strategy in Pediatric Asthma

Hans Bisgaard, MD, DMSci; Pascal Le Roux, MD; Ditlef Bjåmer, MD; Andrzej Dymek, MD; Jan H. Vermeulen, FCP (Paediatrics); Christer Hultquist, MD
Author and Funding Information

Affiliations: *From the Department of Pediatrics (Dr. Bisgaard), Copenhagen University Hospital, Copenhagen, Denmark; Service de Pédiatrie (Dr. Le Roux), Groupe Hospitalier du Havre, Le Havre, France; Poliklinikk for Asthma and Allergy (Dr. Bjåmer), Bekkestua, Norway; Medical Center of Lucyna and Andrzej Dymek (Dr. Dymek), Zawadzkie, Poland; Department of Pediatrics (Dr. Vermeulen), Panorama Mediclinic, Cape Town, South Africa; and AstraZeneca R&D (Dr. Hultquist), Lund, Sweden.,  See Appendix for additional participating investigators.

Correspondence to: Hans Bisgaard, MD, Danish Pediatric Asthma Center, Department of Pediatrics, Copenhagen University Hospital, Gentofte, DK-2900 Copenhagen, Denmark; e-mail: bisgaard@copsac.dk



Chest. 2006;130(6):1733-1743. doi:10.1378/chest.130.6.1733
Text Size: A A A
Published online

Objectives: A fixed combination of long-acting β2-agonists (LABA) plus inhaled corticosteroids (ICS) has never been proven to reduce asthma exacerbations vs ICS alone in children. This 12-month, double-blind, randomized study in 341 children (age range, 4 to 11 years) with asthma uncontrolled on ICS investigated whether a novel regimen using budesonide/formoterol for maintenance and reliever therapy (Symbicort maintenance and relief therapy [SMART]) [Symbicort; AstraZeneca R&D; Lund, Sweden] could reduce exacerbations.

Methods: Patients received SMART (budesonide/formoterol 80/4.5 μg qd maintenance plus additional inhalations for symptom relief), budesonide/formoterol 80/4.5 μg qd for maintenance (fixed combination), or higher-dose budesonide 320 μg qd (fixed-dose budesonide). Blinded as-needed medication (terbutaline 0.4 μg) was provided in both fixed-dose groups.

Results: SMART prolonged the time to first exacerbation vs fixed-dose budesonide (p = 0.02) and fixed-dose combination (p < 0.001). Rates of exacerbation requiring medical intervention were reduced by 70 to 79% with SMART vs fixed-dose budesonide and fixed-dose combination (0.08/patient vs 0.28/patient and 0.40/patient, respectively; both p < 0.001). Mild exacerbation days and awakenings were significantly lower with SMART; yearly growth improved by 1.0 cm vs fixed-dose budesonide (p < 0.01).

Conclusion: The SMART regimen using budesonide/formoterol for both maintenance and as-needed symptom relief reduces the exacerbation rate compared with both fixed-dose combination and higher fixed-dose ICS alone in children with asthma.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Guidelines
Long-term management of asthma.
Finnish Medical Society Duodecim | 1/11/2008
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543