The aim of this study was to investigate relationships between acute exacerbation and Forced Expiratory Volume 1 second (FEV1) improvement after treatment with combined long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD). A total of 137 COPD patients were classified as responders or nonresponders according to FEV1 improvement after 3 months of LABA/ICS treatment in fourteen referral hospitals in Korea. Exacerbation occurrence in these two subgroups was compared over a period of 1 yr. Eighty of the 137 COPD patients (58.4%) were classified as responders and 57 (41.6%) as nonresponders. Acute exacerbations occurred in 25 patients (31.3%) in the responder group and in 26 patients (45.6%) in the nonresponder group (P=0.086). FEV1 improvement after LABA/ICS treatment was a significant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV1, smoking history, 6 min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.
Adrenal Cortex Hormones/*therapeutic use ; Adrenergic beta-2 Receptor Agonists/*therapeutic use ; Bronchodilator Agents/*therapeutic use ; Budesonide/therapeutic use ; Drug Therapy, Combination ; Female ; Fluticasone/therapeutic use ; Forced Expiratory Volume/drug effects/*physiology ; Formoterol Fumarate/therapeutic use ; Humans ; Male ; Pulmonary Disease, Chronic Obstructive/*drug therapy/physiopathology ; Recurrence ; Republic of Korea ; Salmeterol Xinafoate/therapeutic use ; Smoking ; Spirometry ; Treatment Outcome

Asthma is characterized by chronic inflammation of the airways with variable airflow limitation resulting in recurrent wheezing, chest tightness, and cough. Long term management is essential to prevent symptom and asthma exacerbation with using daily controller medications. Asthma control was much improved by combining inhaled corticosteroids with long-acting beta2 agonists. Recent several studies demonstrated the effectiveness of a new asthma management strategy, a single inhaler containing budesonide and formoterol for both maintenance therapy and symptom relief (called SMART) which was approved in GINA guideline, 2006. This SMART strategy could reduce the frequency of severe exacerbations and the need for rescue medicine with systemic steroids as well as improved lung function and asthma controls at relatively lower doses of corticosteroid with lesser costs for treatment.
Adrenal Cortex Hormones ; Asthma* ; Budesonide ; Cough ; Formoterol Fumarate ; Inflammation ; Lung ; Nebulizers and Vaporizers ; Respiratory Sounds ; Steroids ; Thorax

BACKGROUNDS: Although glucocorticoids are one of the most potent anti-inflammatory agents, they have limited effect on cysteinyl leukotriene biosynthesis. In addition, the response to inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABA) combination therapy in moderate to severe persistent asthmatics varies. Additional therapy with leukotriene receptor antagonists (LTRA) in patients with moderate to severe asthma suboptimally controlled with ICS and LABA combination therapy would be complementary to asthma control. METHODS: One hundred and ninety eight asthmatics entered a 2 month, open-label descriptive study. Patients suffering from persistent asthma and suboptimally controlled on a combination therapy of fluticasone/salmeterol or budesonide/ formoterol were given montelukast 10 mg daily as an add-on therapy. The level of asthma control was assessed using the Asthma Control Questionnaire (ACQ) including FEV(1) % predicted at the baseline and after a 2-month treatment with montelukast. A global evaluation of the treatment was also made by the patients and physicians. RESULTS: The mean ACQ score decreased significantly on montelukast (11.5+/-5.4 at baseline vs. 6.7+/-5.0), with a significant improvement in all individual symptom scores (p<0.01). The FEV(1) % predicted values did not show any significant change. 59.9% of patients and 59.4% of physicians reported global improvement in their asthma (kappa=0.85). CONCLUSION: These results suggest that the addition of montelukast in patients with persistent asthma that is suboptimally contolled by combination therapy of ICS and LABA might confer complementary effects on asthma control.
Adrenal Cortex Hormones* ; Anti-Inflammatory Agents ; Asthma ; Glucocorticoids ; Humans ; Leukotriene Antagonists ; Surveys and Questionnaires ; Formoterol Fumarate

The aim of this study was to examine the daily practice patterns of Symbicort® Maintenance and Reliever Therapy (SMART) in Korean asthmatic patients and to analyze clinical signs related to overuse. This study used an observational, multicenter, noninterventional, prospective, uncontrolled design for examining asthmatic patients prescribed SMART to assess the frequency and pattern of Symbicort® usage as a maintenance and reliever medication. The characteristics of patients showing signs of overuse (frequency of inhalation: 8 or more times per day) were also analyzed. Among the 1,518 patients analyzed, 1,292 (85.1%) completed the trial. The number of mean inhalations per day was 2.14±1.15; the number of patients who had at least 1 as needed usage (PRN) inhalation per day was 843 (55.5%); the mean frequency of PRN use was 0.25±0.67 inhalations per day. The number of patients who overused for at least 1 day was 260 (17.1%). In particular, young patients, patients with limited physical activity, and patients with nocturnal symptoms demonstrated high frequency of overuse. The frequency of overuse during SMART was not high in Korean asthmatic patients and the asthma status of follow-up outpatients improved overall. However, there is a need for careful education targeted toward younger patients, patients with limited physical activity, and patients with nocturnal symptoms owing to their tendency to frequently overuse.
Asthma ; Budesonide ; Education ; Follow-Up Studies ; Formoterol Fumarate ; Humans ; Inhalation ; Korea ; Motor Activity ; Outpatients ; Prescription Drug Overuse ; Prospective Studies

OBJECTIVETo compare the bronchodilating effect of RR-formoterol (RR-FMT) with that of racemic formoterol (rac-FMT) on human bronchus.

METHODSHuman bronchial spiral strips (2 - 4 mm internal diameter,15 mm length) were suspended in tissue baths under resting tension of 1.0 g. The changes of tension induced by RR-FMT and rac-FMT(10 pmol x L(-1) - 3.2 micromol x L(-1)) in a cumulative concentration manner were studied under resting tension conditions or precontraction with carbamylcholine (10 micromol x L(-1)) or histamine(100 micromol x L(-1)) in human bronchus.

RESULTThe bronchodilating effect of RR-FMT was more potent than that of rac-FMT under resting condition(P<0.05). RR-FMT and rac-FMT reversed histamine or carbamylcholine-induced contraction, and the bronchodilating effect of RR-FMT was more potent than that of rac-FMT (P<0.05).

CONCLUSIONThe bronchodilating effect of RR-FMT is more potent than that of rac-FMT in both the resting condition and carbamylcholine or histamine-induced contraction in human bronchus in vitro.

Aged ; Bronchi ; drug effects ; physiology ; Bronchodilator Agents ; pharmacology ; Carbachol ; pharmacology ; Dose-Response Relationship, Drug ; Ethanolamines ; pharmacology ; Formoterol Fumarate ; Histamine ; pharmacology ; Humans ; In Vitro Techniques ; Middle Aged ; Stereoisomerism

Administration, Inhalation ; Asthma ; drug therapy ; physiopathology ; Budesonide ; administration & dosage ; Drug Combinations ; Eosinophils ; drug effects ; Ethanolamines ; administration & dosage ; Formoterol Fumarate ; Humans ; Peak Expiratory Flow Rate ; Powders

BACKGROUNDMany studies have shown the superior efficacy of budesonide (BUD)/formoterol (FORM) maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol (SALM)/fluticasone (FP) maintenance plus an as-needed short-acting β(2)-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study (NCT00242775).

METHODSA total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM+as-needed BUD/FORM (160/4.5 µg/inhalation) (640/18 µg/d; n = 111), or SALM/FP+as-needed terbutaline (0.4 mg/inhalation) (100/1000 µg/d; n = 111). The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life.

RESULTSTime to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment (risk ratio = 0.52, 95%CI 0.22 - 1.22), but the difference did not achieve statistical significance (P = 0.13). The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group (7.2% vs. 13.5%; risk ratio = 0.45, P = 0.028). BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days (%), and morning/evening peak expiratory flow (PEF) than SALM/FP (P < 0.05 in all cases). The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second (FEV(1)), asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening(s). Both treatments were well tolerated.

CONCLUSIONSIn Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the original study.

Adolescent ; Adult ; Aged ; Asthma ; complications ; drug therapy ; physiopathology ; Budesonide ; administration & dosage ; adverse effects ; Double-Blind Method ; Ethanolamines ; administration & dosage ; adverse effects ; Female ; Forced Expiratory Volume ; Formoterol Fumarate ; Humans ; Male ; Middle Aged