Treatment of asthma using combination of inhaled corticosteroids and β2-agonist

Klinika Gruźlicy, Chorób i Nowotworów Płuc I Katedry Chorób Wewnętrznych Uniwersytetu Medycznego w Łodzi.
Kierownik Kliniki: prof. dr hab. n. med. Iwona Grzelewska-Rzymowska
WZ ZOZ Centrum Leczenia Chorób Płuc i Rehabilitacji w Łodzi. Dyrektor: inż. Janusz Kazimierczak
Correspondence to: Klinika Gruźlicy, Chorób i Nowotworów Płuc Uniwersytetu Medycznego w Łodzi, ul. Okólna 181,
91-520 Łódź, tel./faks: 042 617 72 95, e-mail:
Source of financing: Department own sources

Pediatr Med rodz Vol 5 Numer 3, p. 178-185

This review assesses the evidence regarding the use asthma-treatment with combination long-acting β2-agonist (LAβA) and inhaled corticosteroid (ICS). The first line-treatment in asthma is inhaled corticosteroid. The integral part of asthma management is β2-agonist, which present the strongest bronchodilators. Currently, two long-acting β2-agonist – salmeterol and formoterol are widely available. Recently several clinical studies have proved that LAβAs in combination with ICS are effective and safe option in asthma management. GINA guidelines recommend the addition of LAβAs to a low and medium dose ICS, when low doses of ICS do not allow to achieve control of asthma symptoms. From some clinical trials we have knowledge that LAβAs given in combination with ICS demonstrate that addition LAβAs is more beneficial in control asthma symptoms than doubling dose of ICS. Asthma is a chronic inflammatory disease of the airways with their hyperresponsiveness. The clinical course of asthma is usually different in different patients and even in the same subject. In normal clinical practice, a maintenance dose of ICS appropriate to the severity of the patient’s asthma of either combination of ICS and LAβA is administered twice daily, and a separate β2-agonist (SAβA – short acting β2-agonist) is used as needed to relieve asthma symptoms. Recently a new model of combination of ICS budesonide and LAβA (formoterol) in one inhaler has been proposed. This model is called SMART (Single Maintenance and Reliever Therapy). In this treatment concept combination budesonide/formoterol in one inhaler is used for both maintenance and as-needed therapy for symptoms relief, without a separate rescue medication. Several clinical trials have shown that SMART method reduced the risk of severe exacerbations and was well tolerated. This method has a beneficial role in patients who remain symptomatic despite treatment with combination maintenance therapy.

Keywords: asthma, inhaled corticosteroids, long acting β2-agonist, combination therapy, maintenance and reliever medication