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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Short-acting beta2 agonists called SABA (Salbutamol, Terbutaline) are widely used as rescue symptomatic therapy. Long-acting beta2 agonists called LABA (Salmeterol, Formoterol, Vilanterol) are currently generally recommended as the first choice for patients who have symptoms that persist despite regular inhaled corticosteroids. Salmeterol is a partial agonist of the beta2 receptor whilst formoterol is a full agonist. Both appear to have similar clinical effects, but formoterol has a more rapid onset of action. Side effects of tachycardia, tremor and muscle cramps are rarely a problem unless given in high doses. Clinically important tachyphylaxis to the airway smooth muscle effects of LABA is not thought to occur.
Respiratory Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Regardless of availability of spirometry and peak flow meter data, a stepwise approach to medications can be used (Figure 11.7.2). It differs from asthma in that bronchodilators are the mainstay: inhaled SABAs, LABAs and short- and long-acting muscarinic receptor antagonists (SAMAs and LAMAs; anticholinergics). Inhaled corticosteroids are used only in combination with LABA/LAMA for patients with more severe disease. Any corticosteroid inhaler should be discontinued promptly if no response, as its use in COPD increases the risk of pneumonia. Systemic corticosteroids are used for exacerbations.
Pediatric Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Michael Teik Chung Lim, Mahesh babu Ramamurthy, Daniel Yam-Thiam Goh
Checking and correcting these six steps usually help to achieve better asthma control in most children. However, a minority of children will still have persistent symptoms. These are the difficult-to- treat asthmatics who will need escalation of medications. In children less than 5 years of age, either the dose of ICS is doubled or montelukast is added. In children over 6 years of age, LABA is added to ICS.
Impact of asthma control on quality of life in an outpatient setting in Brazil
Published in Journal of Asthma, 2023
Cristina Bassi Lourenco, Franco Martins, Elie Fiss, Anete Sevciovic Grumach
Combination of ICS-LABA was used by 40 patients (85.1%) as controller treatment. All patients on medium and high dose ICS were also taking LABA as part of their controller treatment. SABA was used by 25 patients as rescue medication. Only one female patient used as-need ICS-formoterol reliever or MART therapy (maintenance and reliever therapy with ICS-formoterol), she was taking high dose of ICS-LABA and her asthma was classified as uncontrolled. None of the 6 patients taking high dose ICS-LABA had controlled asthma. Another female patient was taking oral corticosteroids chronically (5 mg of prednisone) in association with high dose ICS-LABA and her asthma was classified as partially controlled. In our cohort, no patient was receiving biologic therapy, such as Anti-IgE, Anti-IL-5/Anti-IL-5R or Anti-IL4R.
Fluticasone furoate plus vilanterol in patients with moderate persistent asthma: a cost-utility analysis
Published in Journal of Asthma, 2023
Jefferson Antonio Buendía,, Diana Guerrero Patiño
Inhaled corticosteroids are the cornerstone of asthma treatment. However, between 5% and 10% of patients do not respond to these drugs, requiring comprehensive treatment to achieve asthma control (1,2). Inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) combination is recommended for patients whose asthma remains uncontrolled with an ICS alone (3). The annual healthcare costs of these patients are three times those of patients with controlled asthma (3). Finding cost-effective treatments for these patients is a priority, due to the large economic burden generated by severe asthma (4–7). It is recognized that poor adherence is a major issue among patients with uncontrolled asthma (7). 12-month discontinuation rates for ICS/LABA such as fluticasone propionate plus salmeterol or budesonide/formoterol can be as high as 55% (8).
A review of the efficacy and safety of fluticasone propionate/formoterol fixed-dose combination
Published in Expert Review of Respiratory Medicine, 2022
Satish Chandra Kilaru, Avya Gopal Bansal, Vaishali Sandeep Naik, Meena Lopez, Jaideep Ashok Gogtay
ICS/LABA combination therapy has been widely acknowledged as having revolutionized the management of asthma and COPD. Among the many options available, the FP/FORM combination has shown promising results in comparative studies. Various clinical trials that evaluated the efficacy of this combination have reported its superiority over FP and FORM monotherapies. With respect to the concurrent use of FP and FORM in separate inhalers, they are as effective as the FP/FORM combination but patient adherence to therapy might be a cause for concern. Most of the efficacy studies comparing FP/FORM with other ICS/LABA fixed-dose combinations have also demonstrated the non-inferiority of FP/FORM to FP/SAL and BUD/FORM at equivalent doses. There is also substantial evidence suggesting that FP/FORM has a faster onset of action than FP/SAL. Further, the safety and tolerability data has shown that the FP/FORM combination therapy is safe to administer in pediatric, adult and adolescent patients with a diagnosis of asthma and COPD.