Fixed-Dose combination of the inhaled corticosteroid and long-acting beta₂-agonist therapy in adults with persistent asthma

ABSTRACT

Introduction: Asthma is a respiratory condition characterized by airway inflammation, airflow obstruction, and bronchial hyperresponsiveness. The standard treatment of asthma comprises inhaled corticosteroid and beta₂-agonist. Inhaled short-acting-beta₂-agonists have been used as rescue medication for exacerbation. However, long-acting-beta₂-agonists (LABA) used as monotherapy for asthma had been reported for having a safety concern. Consequently, it had been recommended as an add-on treatment to inhaled corticosteroid (ICS) in moderate to severe persistent asthma. The fixed-dose combination (FDC) of ICS and LABA has been approved since the year 2000. Evidences revealed using the combination of these medications is more effective in asthma control.

Areas covered: The rational and phase III onward randomized-controlled studies were reviewed. Sources of evidences were from studies published in Medline until November 2015.

Expert opinion: There are six FDC inhaler regimens approved worldwide. The significant synergistic effects of ICS and LABA in one device are well evidenced. A FDC reduces the daily dosage of ICS and asthma exacerbation. It is safe to use regularly as controller. The efficacy of each individual combination on asthma treatment is generally similar. Clinical experience, ease of use, cost and side effects of medication would guide the clinician’s preferences.

KEYWORDS:

• Asthma
• fixed-dose combination
• inhaled corticosteroid
• long-acting Beta₂-agonist

Article highlights

• There are six fixed-dose combination (FDC) inhaler regimens worldwide.

• It is safe to use regularly as fixed-dose controller.

• Inhaled corticosteroid and long-acting-beta₂ bronchodilator in one device is the most effective combination therapy available for persistent asthma.

• The efficacy of each individual combination on asthma treatment is generally similar.

• Future combination of safer and more effective anti-inflammatory inhaler without corticosteroid could be a better alternative option.

This box summarizes key points contained in the article.

Declaration of interest

The authors were supported by the Faculty of Medicine, Chulalongkorn University. H Chantaphakul has received research grants from AstraZeneca and Cephalon and has received funding from Chulalongkorn University. K Ruxrungtham has received lecture and/ or conference support from GlaxoSmithKline, Merck, Takeda, Novartis, Harn Thai and Thai-Otsuka; funding from Senior Research Scholar of the Thai Research Fund (TRF) and Chulalongkorn University Research Professor Fund. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.