Chantaphakul Hiroshi, Ruxrungtham Kiat
a Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand.
Expert Opin Pharmacother. 2016;17(5):631-42. doi: 10.1517/14656566.2016.1145659. Epub 2016 Feb 15.
Asthma is a respiratory condition characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. The standard treatment of asthma comprises inhaled corticosteroid and beta2-agonist. Inhaled short-acting-beta2-agonists have been used as rescue medication for exacerbation. However, long-acting-beta2-agonists (LABA) used as monotherapy for asthma had been reported for having a safety concern. Consequently, it had been recommended as an add-on treatment to inhaled corticosteroid (ICS) in moderate to severe persistent asthma. The fixed-dose combination (FDC) of ICS and LABA has been approved since the year 2000. Evidences revealed using the combination of these medications is more effective in asthma control.
The rational and phase III onward randomized-controlled studies were reviewed. Sources of evidences were from studies published in Medline until November 2015.
There are six FDC inhaler regimens approved worldwide. The significant synergistic effects of ICS and LABA in one device are well evidenced. A FDC reduces the daily dosage of ICS and asthma exacerbation. It is safe to use regularly as controller. The efficacy of each individual combination on asthma treatment is generally similar. Clinical experience, ease of use, cost and side effects of medication would guide the clinician's preferences.
哮喘是一种以气道炎症、气流阻塞和支气管高反应性为特征的呼吸系统疾病。哮喘的标准治疗包括吸入性糖皮质激素和β2受体激动剂。吸入性短效β2受体激动剂一直被用作急性加重期的急救药物。然而，有报道称长效β2受体激动剂（LABA）单药治疗哮喘存在安全问题。因此，推荐其作为中度至重度持续性哮喘吸入性糖皮质激素（ICS）的附加治疗药物。ICS和LABA的固定剂量组合（FDC）自2000年起已获批准。有证据表明，联合使用这些药物对哮喘控制更有效。
回顾了其合理性及III期以后的随机对照研究。证据来源为截至2015年11月发表在Medline上的研究。
全球有六种FDC吸入器方案获批。ICS和LABA在同一装置中的显著协同作用已得到充分证实。FDC可减少ICS的每日剂量并降低哮喘急性加重的发生率。作为控制药物定期使用是安全的。每种单独组合在哮喘治疗中的疗效通常相似。临床经验、使用便利性、成本和药物副作用将指导临床医生的选择。
