ABSTRACT
El asma se caracteriza por su impacto deletéreo que incluye gran coste económico para el sistema de salud. En pacientes con asma mal controlada a pesar del tratamiento, se propone un régimen de mantenimiento con corticoides inhalados y formoterol. El objetivo del presente estudio observacional retrospectivo fue evaluar las modificaciones espirométricas tras el cambio del medicamento controlador en pacientes con asma moderada a severa asistidos en el Hospital Clínico de Magallanes de Punta Arenas, así como también cuantificar la modificación en el número de exacerbaciones graves (consulta a un servicio de urgencia y/u hospitalización por asma). Participaron 61 adultos con asma moderada a severa (mediana de edad: 60 años [rango: 21-87], mujeres: 69,4%; comorbilidad atópica/alérgica: 79%; otras comorbilidades: 46,8%) en los que se cambió el tratamiento con fluticasona/salmeterol 250/25 μg por budesónida/formoterol 160/4,5 μg. No se observaron cambios significativos en los índices espirométricos tras el cambio. Con el tratamiento inicial, el 46,9% presentó ≥ 1 visita a urgencias (total: 50 consultas). Tras el cambio por budesonida/formoterol, el 21% requirió al menos una visita a urgencias (total: 14 consultas; p < 0,01). La proporción de pacientes con ≥ 2 consultas a urgencias fue de 19,7% con el tratamiento basal y de 1,6% tras el cambio a budesonida/formoterol (p < 0,01). No se observaron diferencias significativas en la cantidad de hospitalizaciones. En este estudio del mundo real de pacientes con asma moderada a grave, el cambio del tratamiento a budesonida/formoterol se asoció con reducción significativa de las consultas a urgencias, a pesar de no detectarse cambios de significación estadística en los índices espirométricos habituales.
Asthma is characterized by its deleterious impact, including a high cost to the healthcare system. In patients with poorly controlled asthma despite treatment, a maintenance regimen of inhaled corticosteroids and formoterol is proposed. The aim of this retrospective, observational study was to evaluate the spirometric changes after switching the controller medication in patients with moderate to severe asthma attended in our institution ("Hospital Clínico de Magallanes"), as well as the variation in the number of severe exacerbations (consultation to an emergency department and/or hospitalization for asthma). Sixty-one adults with moderate to severe asthma (median age: 60 years-old [range: 21-87], women: 69.4%; atopic/allergic comorbidity: 79%; other comorbidities: 46.8%) in whom treatment with fluticasone/salmeterol 250/25 μg was switched to budesonide/formoterol 160/4.5 μg participated in our study. No significant changes in spirometric parameters were observed after the replacement treatment. With the initial treatment, 46.9% patients presented ≥ 1 visit to the emergency department (total: 50 visits). After the switch to budesonide/formoterol, 21% required at least one emergency department visit (total: 14 consultations; p < 0.01). The proportion of patients with ≥ 2 emergency department visits was 19.7% with baseline treatment and 1.6% after switching to budesonide/formoterol (p < 0.01). No significant differences were observed in the number of hospitalizations. In this real-world study of moderate to severe asthma patients, switching to budesonide/formoterol was associated with a significant reduction in emergency department visits, despite no statistically significant changes in the usual spirometric parameters.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Asthma/drug therapy , Spirometry , Budesonide/administration & dosage , Formoterol Fumarate/administration & dosage , Bronchodilator Agents/administration & dosage , Drug Administration Schedule , Forced Expiratory Volume , Retrospective Studies , Drug Therapy, Combination , Fluticasone-Salmeterol Drug Combination/administration & dosageABSTRACT
Objective To investigate the clinical effect of budesonide/formoterol single inhaler combined with tiotropium bromide in stable chronic obstructive pulmonary disease (COPD).Methods 80 cases of patients with stable COPD in China Aviation Industrial Xi'an Hospital from May 2014 to May 2016 were divided into observation group and control group,40 cases in each group.Patients in the control group were treated with budesonide/formoterol single inhaler,and in the observation group were treated with budesonide/formoterol single inhaler combined with tiotropium bromide.Compared the pulmonary function,life quality,serum levels of matrix metalloproteinases 9 (MMP-9) and interleukin 6 (IL-6),drug adverse reaction during the treatment and exacerbations episodes within the next six months.Results After treatment,the FEV1,FEV1/FVC,FEV1％ of two groups were significantly higher than before treatment (P ＜ 0.05),and in the observation group were significantly higher than that in control group (P ＜ 0.05).SGRQ scores,serum levels of MMP-9 and IL-6 of two groups were significantly lower than before treatment (P ＜ 0.05),and these indexes in the observation group were significantly lower than that in control group (P ＜ 0.05).The differences in the adverse reaction rate of two groups has no significant,the number of acute exacerbation in observation group were significantly lower than that of control group (P ＜ 0.05).Conclusion Budesonide/formoterol single inhaler combined with tiotropium bromide has remarkable clinical effect in stable COPD,and can effectively improve the pulmonary function,life quality,reduce the number of acute exacerbation,and reduce the serum levels of MMP-9,IL-6.
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OBJECTIVE:To observe clinical efficacy and safety of tiotropium bromide combined with budesonide formoterol in the treatment of severe bronchial asthma in adults. METHODS:A total of 110 adult patients with severe bronchial asthma were selected from our hospital during Mar. 2013-Mar. 2016 were divided into control group and observation group according to random number table,with 55 cases in each group. Control group was given Budesonide formoterol powder for inhalation,2 inhalations each time,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18 μg,qd,on the basis of con-trol group. Both groups were treated for 6 months. Clinical efficacies as well as ACT scores,respiration function indexes and the times of acute attack of asthma before and after treatment,the occurrence of ADR were compared between 2 groups. RESULTS:The efficiency rate and total response rate of observation group were 54.55% and 96.36%,which were significantly higher than 32.73%,78.18% in control group,with statistical significance(P0.05). After treatment,ACT scores of 2 groups were significantly higher than before treatment;FEV1,FEV1/FVC and PEF were significantly greater than be-fore treatment,PEFR was significantly lower than before treatment;and the indexes in observation group was significantly better than control group,with statistical significance(P0.05). CONCLUSIONS:Tiotropium bromide combined with budesonide formoter-ol in the treatment of severe bronchial asthma in adults can effectively relieve the severity of disease,improve respiration function, reduce the times of acute attack of asthma,and have good therapeutic efficacy and safety.
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Objective To explore the effect of montelukast combined with budesonide for treating acute bronchial asthma, pulmonary function improvement and to provide the basis for clinical treatment.Methods 192 patients with acute asthma were selected.They were divided into the control group and the observation group according to the admission order and odd and even numbers randomly, 96 patients in each group.The control group was treated with budesonide based on routine treatment, and the observation group was given budesonide formoterol based on the control group.The clinical effect, pulmonary function (forced expiratory volume in one second (FEV1),FEV1/forced vital capacity (FVC) and peak expiratory flow (PEF) the percentage of predicted value index percentage were observed.The daytime and night asthma symptoms and airway reactivity score: early respiratory resistance (Rrsc) and response threshold (Dmin) were assessed.Results The cough disappeared, shortness of breath, wheezing relieving, moist rales disappeared and wheeze disappeared time of the observation group after treatment were (5.92±1.03)d,(3.48±0.71)d,(3.74±0.69)d,(5.32±0.96)d and (5.12±0.77)d, which were lower than those of the control group (t=9.31,7.26,8.11,9.02,8.31,all P<0.05).The daytime and nighttime asthma symptom scores of the observation group after treatment were (0.54±0.31)points and (0.62±0.29)points, which were lower than those of the control group (t=7.90,7.33,all P<0.05).Rrsc score of the observation group after treatment was (2.20±0.56)points, which was lower than that of the control group (t=7.86,P<0.05).The Dmin score of the observation group after treatment was (8.33±0.81)points, which was higher than that of the control group (t=9.15,P<0.05).FEV1,FEV1/FVC and PEF of the two groups after treatment were significantly higher than those before treatment(all P<0.05).FEV1,FEV1/FVC and PEF of the observation group after treatment were (2.95±0.58)L,(71.91±0.69) and (96.45±6.11), which were higher than those of the control group after treatment (t=7.60,9.45,10.21,all P<0.05).Conclusion Montelukast combined with budesonide formoterol in the treatment of acute attack of bronchial asthma has better effect, could significantly reduce the symptoms of asthma patients and shorten the treatment time with synergistic effect, and improve the pulmonary ventilation function of the patients.
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Objective To compare large dose or conventional dose of budesonide/formoterol fumarate powder in treatment of stable chronic obstructive pulmonary disease(COPD).Methods 120 patients with stable COPD from March 2015 to March 2016 in Jiaxing Second hospital were selected,were treated with budesonide/formoterol,and were divided into the conventional dose group and high dose groupaccording to different doses,60 cases in each group.Pulmonary function tests,CAT Chinese version scale assessment and 6 min walking distance(6MWD)test were performed before and after treatment,and adverse reactions and acute attack were observed.Results FEV1/FVC and FEV1％were significantly improved after treatment in the two groups,and those in the high dose group were significantly better than those in the conventional dose group,the difference was statistically significant(P<0.05),CAT score and 6MWD were significantly improved after treatment in the two groups,and those in the high dose group were significantly higher than those in the conventional dose group,the difference was statistically significant(P<0.05),adverse reactions such as palpitations,tachycardiain the high dose group were significantly higher than those in the conventional dose group,while the acute attack rate was significantly lower than that of the conventional dose group,the difference was statistically significant(P<0.05).Conclusion High dose of budesonide/formoterol inhalation in the treatment of patients with stable COPD powder can improve the pulmonary function and health status,but adverse reactions increase.
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Objective To study the effect of psychological intervention combined with the analysis of Budesonide and Formoterol Fumarate Powder for Inhalation in treatment of chronic obstructive pulmonary disease. Methods 100 patients with chronic obstructive pulmonary disease treated in our hospital from February 2015 to March 2016 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group was treated with the Budesonide and Formoterol Fumarate Powder for Inhalation treatment,the experimental group on the basis of psychological intervention on the mental status of patients and patients,strengthen communication and exchanges, increase confidence in the treatment and the treatment compliance of patients. Results After treatment, the SGRQ score of the experimental group was (57.33±16.81), and the score of the control group was (43.86±12.68) points, with statistical difference (P<0.05). The scores of depression and anxiety in the experimental group were significantly better than those in the control group,with statistical difference(P<0.05). Conclusion Budesonide and Formoterol Fumarate Powder for Inhalation combined with mental intervention in the treatment of chronic obstructive pulmonary disease can significantly improve the patients, improve the quality of life, help patients recover as soon as possible, has clinical significance.
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Objective To investigate the effect of ipratropium bromide combined with budesonide /formoterol fumarate inhalation powder on serum FeNO and lung function of bronchial asthma patients.Methods 102 cases with clear bronchial asthma during Jan 2013 and Mar.2015 from the affiliated Qianfo Hill Hospital of Shandong University were randomly divided into three groups, control group A (34 cases) were treated with ipratropium bromide, control group B (34 cases) were treated with budesonide/formoterol fumarate powder, experiment group (34 cases) were given ipratropium bromide combined with budesonide/formoterol fumarate powder, all groups were treated for 6 months.Pulmonary function, serum FeNO and IgE levels, clinical efficacy were compared after treatment.Results The effective rate of control group A, B (70.59%, 67.65%) were significantly lower than experiment group (91.18%), the difference were significant (P<0.05).FEV1, FVC, FEV1%pre of experiment group were significantly higher than control group A and B after the treatment.Serum IgE and FeNO concentration were significantly lower than control group A, B, the difference were significant ( P<0.05 ) .Conclusion Ipratropium bromide combined with budesonide/formoterol fumarate powder for inhalation in bronchial asthma patients can effectively reduce FeNO concentration, improve lung function.
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OBJECTIVE:To review economics of budesonide/formoterol and fluticasone/salmeterol for asthma systematically, and to provide evidence-based basis for rational selection of drug to treat asthma. METHODS:Retrieved from Medline,EMBase, EBM reviews (HTA,NHSEED),CBM,CJFD,Wanfang database,researches about pharmacoeconomics of budesonide/formoterol (test group) versus fluticasone/salmeterol (control group)for asthma were collected,and analyzed with qualitative systematic re-view method. RESULTS:A total of 7 researches and 13 comparative data were included,containing 6 682 patients. The incidence of severe acute asthma of test group were lower than those of control group,with significant difference(P<0.05). The total costs and direct costs of test group were lower than those of control group. Good effect had been achieved in test group with low cost. CONCLUSIONS:Budesonide/formoterol is more cost-effective than fluticasone/salmeterol in teenagers patients and adults who fail to control asthma. Due to limitation of included studies,large-scale and high-quality studies are required for further validation of the conclusion.
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Objective To compare the efficacy between budesonide/formoterol single inhaler therapy and budesonide inhaler plus formoterol inhaler in children with bronchial asthma.Methods In randomized, open, parallel-group trial, 80 cases of children with bronchial asthma in children asthma center of Children's Hospital of Hebei Province were divided into B/F group ( budesonide/formoterol single inhaler therapy ) and B +F group (budesonide inhaler plus formoterol inhaler), 40 cases in each group.All patients in B/F group inspired budesonide formoterol sing inspirator [80μg (budesonide)/4.5μg(formoterol)/snuff], and all patients in B+F group inspired budesonide(100μg/snuff) and formoterol(4.5μg/snuff), 1 snuff/time, respectively, both groups were treated with 2 times/d,12 weeks.The visual analog scale(VAS), lung function as forced expiratory volume in one second(FEV1)%, peak expiratory flow(PEF) and clinical symptoms were investigated.Results Compared with B+F group in the same time period, PEF% and FEV1%on the 12th week were higher, VAS score on the 4th, 8th and 12th week were lower, symptoms scores on 8th and 12th were lower in B/F group, respectively(P<0.05).Conclusion The efficacy of budesonide/formoterol single inhaler therapy is better than that of budesonide inhaler plus formoterol inhaler in children with bronchial asthma, which is more convenience and has a better compliance.
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Objective To observe the clinical effect of therapy of budesonide/formoterol powder for inhalation in treatment of adult with bronchial asthma.Methods 90 cases with bronchial asthma and were divided into observation group and control group randomly from February 2014 to February 2015.45 cases in each group.Control group was treated with budesonide inhalants +formoterol inhalants, observation group was given budesonide/formoterol powder inhalation.Changes of related indicators were followed up and recorded.Results After treatment, IL-5, IL-12 and IFN-γwere (60.2 ±9.7)pg/mL,(31.4 ±3.1)pg/mL,(1.6 ±0.2) ng/mL of observation group were better than control group (72.8 ±10.7)pg/mL,(38.5 ± 5.6)pg/mL,(2.3 ±0.3) ng/mL (P<0.05).After treatment,total effective rate in observation group was 68.9%, which was better than control group (48.9%)(P<0.05).Conclusion Clinical effect of budesonide/formoterol powder for inhalation in treatment of patients with bronchial asthma is accurate, and there is no obvious adverse reaction.
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Objective To evaluate the efficacy of Budesonide/formoterol to control asthma under real-life conditions.Methods A muhi-center, open label, non-interventional study was conducted.Asthma control after 12 week therapy with Budesonide/formoterol was assessed by Asthma Control Questionnaire (ACQ) and modified Asthma Control Questionnaire (ACQ5).Results A total of 360 asthma patients were recruited,including 228 adult patients and 132 child patients.After 12 weeks' therapy,all the patients' medium value of ACQ was decreased significantly from 2.03 (adults 2.20, children 1.74) at baseline to 0.60 (adults 0.78, children 0.29) (P < 0.0001), and the medium value of ACQ5 was also decreased significantly from 2.4 (adults 2.24, children 1.76) at baseline to 0.47 (adults 0.62, children 0.20) (P < 0.0001).Conclusion Budesonide/formoterol is effective in asthma treatment, by which most asthma patients obtain and maintain clineal control.
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OBJECTIVE: To evaluate the efficacy and the safety of low dose budesonide/formoterol combination therapy vs.medium dose of budesonide(BUD) dry powder in the management of mild or moderate adult asthma.METHODS: A total of 62 patients with asthma were randomized to Group A(budesonide plus formcterol) or Group B(budesonide).Main outcome measures: daytime symptom and nocturnal symptom,peak expiratory flow(PEF),number of times of using rapid-acting ? 2 agonist and its ADR.RESULTS: After treatment,both groups had significant improvement in daytime symptom and nocturnal symptom(number of times of wakeup),PEF value and lung function,and the dosage of rapid-acting ? 2 agonist was decreased,showing significant differences between the two groups.The ADR was light in degree.CONCLUSION: Inhalation therapy of low dose of glucocorticoid plus long-acting ? 2 agonist is an optimal choice in the management of asthma.The efficacy of glucocorticoid could be enhanced more by combination with low dose and long-acting ? 2 agonist than by simply increasing its own dose.