Way forward is not obvious at asthma crossroads

doi:10.1136/bmj.39339.481667.3A

BMJ 2007;335:577 (22 September), doi:10.1136/bmj.39339.481667.3A

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Way forward is not obvious at asthma crossroads

The first 150 words of the full text of this article appear below.

Barnes argues that using a combination inhaler (budesonide plusformoterol) as rescue therapy improves asthma control.¹ Severalstudies support the use of budesonide/formoterol in the SMART(Symbicort (budesonide/formoterol) maintenance and relievertherapy) regimen.² ³ They have shown longer time to first exacerbation,reduced rate of severe exacerbations, and less inhaled corticosteroiddose, although with similar improvement in symptoms, peak flowrates, and quality of life in some studies. The concept lookspromising, but some areas of concern remain.

The main concern is that all the above studies were conductedby the manufacturing firm (study design, data interpretation,data analysis, and publication). Three matching studies fromthe rival manufacturers of fluticasone/salmeterol have shownthe opposite effect—stable dosing reducing exacerbationrate and improving symptom free days compared with the SMARTregimen.⁴

Secondly, in all SMART studies patients needing more than 10as needed inhalations were excluded, and this will have implicationon therapy . . . [Full text of this article]

Syed F Hussain, consultant respiratory physician

Kettering General Hospital, Kettering, Northamptonshire NN16 8UZ

Syed.Hussain@kgh.nhs.uk

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Using a combination inhaler (budesonide plus formoterol) as rescue therapy improves asthma control: Peter J Barnes
BMJ 2007 335: 513. [Extract] [Full Text] [PDF]

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