Effect of adjusting the combination of budesonide/formoterol on the alleviation of asthma symptoms

Ryosuke Souma, Kumiya Sugiyama, Hiroyuki Masuda, Hajime Arifuku, Kentaro Nakano, Hiroyoshi Watanabe, Tomoshige Wakayama, Shingo Tokita, Masamitsu Tatewaki, Hideyuki Satoh, Kenya Koyama, Yumeko Hayashi, Fumiya Fukushima, Hirokuni Hirata, Masafumi Arima, Kazuhiro Kurasawa, Takeshi Fukuda, Yasutsugu Fukushima

The combination of budesonide + formoterol (BFC) offers the advantages of dose adjustment in a single inhaler according to asthma symptoms. We analyzed the relationship between asthma symptoms in terms of peak expiratory flow (PEF) and dose adjustment by the patient. Twenty-eight patients with asthma who used BFC for alleviation of their symptoms (12 men, 16 women; 60 years old) were instructed that the inhaled BFC dose could be increased to a maximum of 8 inhalations per day according to symptom severity. Patients measured and recorded PEF every morning and evening in their asthma diary along with their symptoms and the dose of drugs taken. Sixteen of the 28 patients increased their dose for asthma symptoms. The time to recovery from the asthma symptoms was significantly shorter when cough was the only symptom present compared with dyspnea or wheeze (1.4 vs. 5.3 or 6.6 days, p < 0.05) and when they had only one symptom compared with two or three symptoms (1.3 vs. 5.7 or 10.5, p < 0.01). The relationship between PEF (% of personal best) when the dose was increased (Y) and the days for the increased dose to achieve a PEF greater than PEF in the symptom-free state (X) was determined to be Y = - 0.591X + 89.2 (r2 = 0.299, p < 0.001). As a guide for increasing the BFC dose when patients with mild asthma have asthma symptoms, the dose should be increased when cough is present or PEF is decreased to 88.9% (i.e., X = 0.5).