Daytime and nighttime symptoms
The combination of formoterol/budesonide has recently been approved in the United States for maintenance treatment of asthma. In patients receiving formoterol/ budesonide as maintenance therapy, the use of the combination for rescue therapy on an as-needed basis significantly reduced the exacerbation risk by 45 to 54% vs the use of a short-acting P2-agonist for rescue therapy in two different studies (p < 0.001). Use of the combination for both maintenance and rescue therapy was associated with improvements in lung function and in daytime and nighttime symptoms. In patients who were symptomatic while receiving formoterol/budesonide maintenance therapy, the use of the combination as rescue therapy significantly delayed the time to the first severe exacerbation compared to rescue therapy with formoterol or terbutaline (p = 0.0048). Over the course of the 1-year study, the rate of severe exacerbations with formoterol/budesonide rescue therapy was significantly decreased (vs formoterol: rate ratio, 0.67; 95% CI, 0.56 to 0.80; vs terbutaline: rate ratio, 0.52; 95% CI, 0.44 to 0.62).
Ciclesonide, a novel ICS that is currently in clinical development, is essentially inactive until it is activated by esterases in the lung by a steroid with potent local antiinflammatory activity. Thus, ciclesonide may allow targeted antiinflammatory activity in the lung, causing only minimal local or systemic side effects and, consequently, permitting the use of higher ICS doses. In patients with steroid-dependent asthma, administering ciclesonide, 640 or 1,280 mg/d, significantly reduced oral prednisone requirements by 47% and 63%, respectively; whereas, the oral steroid dose rose slightly in the group receiving placebo (p < 0.0003). After 12 weeks, prednisone therapy was discontinued in approximately 30% of patients receiving ciclesonide vs 11% of those receiving placebo (p < 0.04). The reductions in prednisone dose achieved with ciclesonide therapy were accompanied by improved FEV1 relative to therapy with placebo (p < 0.03) without increasing local or systemic side effects. Thus, ciclesonide may reduce the need for oral steroids in patients Kamagra online with severe asthma while maintaining asthma control.