Buhl R, Vogelmeier C
Pulmonary Department, Mainz University Hospital, Mainz, Germany.
Curr Med Res Opin. 2007 Aug;23(8):1867-78. doi: 10.1185/030079907X210769.
An inhaled corticosteroid (ICS) or an ICS/long-acting beta(2)-agonist (LABA) combination plus short-acting beta(2)-agonist (SABA) as needed for symptom relief is recommended for persistent asthma. Additionally, budesonide/formoterol maintenance and reliever therapy (Symbicort SMART, AstraZeneca, Sweden) has been approved for adults in the European Union. This option is well tolerated and offers greater reductions in asthma exacerbations together with similar improvements in daily symptom control, at a lower overall steroid load, compared with fixed-dose ICS/LABA plus SABA.
Two large clinical trials investigated the use of budesonide/formoterol as maintenance and reliever compared with medium or high doses of an ICS/LABA combination as controller plus SABA as reliever in adults (aged > or = 12 years). COMPASS was a 6-month, double blind, randomized trial while COSMOS was a 1-year, dose titration study which reflected routine clinical practice. The current review focuses on the findings in both studies, among adult patients only (aged > or = 18 years).
Among adults, the studies confirmed a 21-39% reduction in severe exacerbations in patients treated with budesonide/formoterol maintenance and reliever therapy compared with titrated salmeterol/fluticasone plus SABA (COSMOS) or fixed higher budesonide/formoterol or salmeterol/fluticasone plus SABA (COMPASS), respectively. Similar levels of daily asthma control were achieved with budesonide/formoterol maintenance and reliever therapy at a significantly lower overall steroid load compared with salmeterol/fluticasone or budesonide/formoterol plus SABA. Budesonide/formoterol maintenance and reliever therapy was as well tolerated as combination therapies.
In adult patients, budesonide/formoterol maintenance and reliever therapy is a safe and simplified approach to asthma management, using a single inhaler, which reduces severe exacerbations and maintains similar daily asthma control at a lower drug load compared with the traditional strategy of ICS/LABA plus SABA.
对于持续性哮喘，推荐使用吸入性糖皮质激素（ICS）或ICS/长效β2受体激动剂（LABA）联合按需使用短效β2受体激动剂（SABA）以缓解症状。此外，布地奈德/福莫特罗维持和缓解治疗（信必可都保，阿斯利康，瑞典）已在欧盟获批用于成人。与固定剂量的ICS/LABA加SABA相比，该方案耐受性良好，能更大程度减少哮喘急性发作，同时在每日症状控制方面有类似改善，且总体类固醇负荷更低。
两项大型临床试验研究了布地奈德/福莫特罗作为维持和缓解药物与中或高剂量的ICS/LABA联合作为控制药物加SABA作为缓解药物在成人（年龄≥12岁）中的使用情况。COMPASS是一项为期6个月的双盲随机试验，而COSMOS是一项为期1年的剂量滴定研究，反映了常规临床实践。本综述仅关注两项研究中成年患者（年龄≥18岁）的结果。
在成人中，研究证实与滴定剂量的沙美特罗/氟替卡松加SABA（COSMOS）或固定的高剂量布地奈德/福莫特罗或沙美特罗/氟替卡松加SABA（COMPASS）相比，接受布地奈德/福莫特罗维持和缓解治疗的患者严重急性发作减少了21% - 39%。与沙美特罗/氟替卡松或布地奈德/福莫特罗加SABA相比，布地奈德/福莫特罗维持和缓解治疗在总体类固醇负荷显著更低的情况下实现了类似水平的每日哮喘控制。布地奈德/福莫特罗维持和缓解治疗与联合治疗的耐受性相当。
在成年患者中，布地奈德/福莫特罗维持和缓解治疗是一种安全且简化的哮喘管理方法，使用单一吸入器，与ICS/LABA加SABA的传统策略相比，可减少严重急性发作，并在较低药物负荷下维持类似的每日哮喘控制。
Zotero 插件