Researchers say people with chronic asthma have been offered a new hope in the form of an inhaler that contains two medicines.
Asthma sufferers use maintenance or preventive medication regularly to control their symptoms and improve lung function. Preventive medication is usually a low-dose corticosteroid administered with an inhaler device. However, when their symptoms deteriorate, they turn to a different "rescue" inhaler containing a short-acting beta2-agonist, to relieve their wheezing and shortness of breath. If not controlled, this type of asthma exacerbation can lead to hospitalization, a visit to an emergency department or treatment with a course of oral steroids.
Researchers have been investigating the use of both a low-dose corticosteroid (budesonide) and beta2-agonist (formoterol) in a single inhaler.
The systematic review compares the effectiveness of the new inhaler to the current "best practice" of separate inhalers for different phases of asthma treatment.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care.
"Encouraging people to use their preventive medication is important, as it is often the case that people with asthma default on their inhaled corticosteroids," said lead reviewer Christopher Cates, M.D., at the Community Health Sciences of St. George's at the University of London.
"This is partly because inhaled steroids do not make an immediate difference to asthma symptoms," the expert added.
In most studies, participants had treatment with a single inhaler, one inhalation of 80/4.5 milligrams of budesonide/formoterol twice daily, and as needed. Patients in the control groups used their prescribed inhaled corticosteroid with a separate reliever inhaler. Cates and his colleague evaluated three studies that included more than 4,200 adults and adolescents with chronic asthma. One study also included 224 children.
The Cochrane reviewers found no significant reduction in the number of asthma exacerbations that required hospitalization among the patients who used single inhaler therapy.
However, the reviewers did find that fewer adults on single inhaler therapy had exacerbations needing a course of oral corticosteroids. Compared with 18 people of 100 in the control inhaled corticosteroid group who had an exacerbation treated with oral steroids over 11 months, there were 11 of 100 for the single inhaler therapy group.
"One attraction of the combined inhalers is that the inhaled corticosteroid is automatically taken with the beta-agonist, which does relieve symptoms," said Cates.
"Single-inhaler therapy takes this one stage further, as the inhaled corticosteroid is automatically increased, with the beta-agonist, if the asthma symptoms worsen. This approach shows clear advantages in comparison to taking inhaled corticosteroids alone, but is less convincing when compared to current best practice," the expert added.