Effect of adjusting the combination of budesonide/formoterol on the alleviation of asthma symptoms

Ryosuke Souma; Kumiya Sugiyama; Hiroyuki Masuda; Hajime Arifuku; Kentaro Nakano; Hiroyoshi Watanabe; Tomoshige Wakayama; Shingo Tokita; Masamitsu Tatewaki; Hideyuki Satoh; Kenya Koyama; Yumeko Hayashi; Fumiya Fukushima; Hirokuni Hirata; Masafumi Arima; Kazuhiro Kurasawa; Takeshi Fukuda; Yasutsugu Fukushima

doi:10.1186/s40733-018-0043-8

Effect of adjusting the combination of budesonide/formoterol on the alleviation of asthma symptoms

Asthma Res Pract. 2018 May 21:4:7. doi: 10.1186/s40733-018-0043-8. eCollection 2018.

Authors

Ryosuke Souma¹, Kumiya Sugiyama¹, Hiroyuki Masuda¹, Hajime Arifuku¹, Kentaro Nakano¹, Hiroyoshi Watanabe¹, Tomoshige Wakayama¹, Shingo Tokita¹, Masamitsu Tatewaki¹, Hideyuki Satoh¹, Kenya Koyama¹, Yumeko Hayashi², Fumiya Fukushima², Hirokuni Hirata¹, Masafumi Arima³, Kazuhiro Kurasawa³, Takeshi Fukuda², Yasutsugu Fukushima¹

Affiliations

¹ 1Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, 2-1-50 Minami-koshigaya, Koshigaya, Saitama 343-8555 Japan.
² 2Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, 880 Kita-kobayashi, Mibu, Tochigi 321-0293 Japan.
³ 3Department of Rheumatology, Dokkyo Medical University, 880 Kita-kobayashi, Mibu, Tochigi 321-0293 Japan.

Abstract

Background: The combination of budesonide + formoterol (BFC) offers the advantages of dose adjustment in a single inhaler according to asthma symptoms. We analyzed the relationship between asthma symptoms in terms of peak expiratory flow (PEF) and dose adjustment by the patient.

Methods: Twenty-eight patients with asthma who used BFC for alleviation of their symptoms (12 men, 16 women; 60 years old) were instructed that the inhaled BFC dose could be increased to a maximum of 8 inhalations per day according to symptom severity. Patients measured and recorded PEF every morning and evening in their asthma diary along with their symptoms and the dose of drugs taken.

Results: Sixteen of the 28 patients increased their dose for asthma symptoms. The time to recovery from the asthma symptoms was significantly shorter when cough was the only symptom present compared with dyspnea or wheeze (1.4 vs. 5.3 or 6.6 days, p < 0.05) and when they had only one symptom compared with two or three symptoms (1.3 vs. 5.7 or 10.5, p < 0.01). The relationship between PEF (% of personal best) when the dose was increased (Y) and the days for the increased dose to achieve a PEF greater than PEF in the symptom-free state (X) was determined to be Y = - 0.591X + 89.2 (r² = 0.299, p < 0.001).

Conclusion: As a guide for increasing the BFC dose when patients with mild asthma have asthma symptoms, the dose should be increased when cough is present or PEF is decreased to 88.9% (i.e., X = 0.5).

Keywords: Adjustable maintainable dose (AMD); Asthma; Budesonide; Formoterol; Peak expiratory flow (PEF); Symbicort maintenance and reliever therapy (SMART).