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Mild asthma that responds well to inhaled budesonide may be controlled with reduced-dose maintenance therapy, but discontinuing budesonide may cause asthmatic symptoms to worsen. Of 37 asthma patients who had been treated for two years with 1200 micrograms per day of budesonide, 19 were switched to 400 micrograms per day of budesonide and 18 were switched to placebo, that is, discontinuation of budesonide. Another 37 patients who had been treated for two years with the inhaled bronchodilator terbutaline were switched to 1200 micrograms per day of budesonide. Most of the 19 patients who received the reduced dose of budesonide maintained good lung function and bronchial reactivity; only two were withdrawn because of worsening symptoms. In contrast, the condition of patients who discontinued budesonide declined. Patients who switched to budesonide from terbutaline showed improvement in lung function, but not as much as those who took budesonide from the beginning of the study.

Asthma treatment has usually consists of the use of bronchodilators to open the airways. Theophylline and beta-2-agonists, two classes of drugs that improve the flow of air being expelled from the lungs, do not treat the underlying inflammation that causes changes in the mucous membranes in the airway. The effects of terbutaline, a beta-2-agonist, and budesonide, a steroid, were compared in 97 newly diagnosed asthma patients who were followed-up over two years. Both drugs were administered by inhalation. Budesonide produced greater improvement in both objective and subjective measures. During the first 12 weeks of treatment most patients taking budesonide improved and did not need further medication. During this period, the use of a supplemental medication decreased by 70 percent among those taking budesonide, and increased by 21 percent among those taking terbutaline. A different study has suggested that the use of beta-2-agonists causes a deterioration in the control of asthma in most patients over time because it temporarily relieves symptoms without affecting the underlying inflammation. Peak expiratory flow (PEF, the rate of breath, in liters per minute, that is breathed out from the lungs) increased, and less supplemental medication was needed with budesonide, and the asthma symptom scores of the patients were much lower. In addition, more of the patients taking terbutaline stopped taking the medication because their symptoms worsened, and they required more therapy with other asthma medications. Early use of inhaled steroids, such as budesonide, may improve asthma symptoms, and lead to long-lasting remission, decreased mortality, and lower treatment costs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Oral corticosteroids and inhaled bronchodilators with or without antibiotics represent standard treatment of COPD exacerbations of moderate severity. Frequent courses of oral steroids may be a safety issue. We wanted to evaluate in an out-patient setting whether a 2-week course of inhaled budesonide/formoterol would be equally effective for treatment of acute COPD exacerbations as standard therapy in patients judged by the investigator not to require hospitalisation. Methods This was a double-blind, randomised, non-inferiority, parallel-group, multicentre study comparing two treatment strategies; two weeks' treatment with inhaled budesonide/formoterol (320/9 μg, qid) was compared with prednisolone (30 mg once daily) plus inhaled formoterol (9 μg bid) in patients with acute exacerbations of COPD attending a primary health care centre. Inclusion criteria were progressive dyspnoea for less than one week, FEV1 30–60% of predicted normal after acute treatment with a single dose of oral corticosteroid plus nebulised salbutamol/ipratropium bromide and no requirement for subsequent immediate hospitalisation, i.e the clinical status after the acute treatment allowed for sending the patient home. A total of 109 patients (mean age 67 years, 33 pack-years, mean FEV1 45% of predicted) were randomized to two weeks' double-blind treatment with budesonide/formoterol or prednisolone plus formoterol and subsequent open-label budesonide/formoterol (320/9 μg bid) for another 12 weeks. Change in FEV1 was the primary efficacy variable. Non-inferiority was predefined. Results Non-inferiority of budesonide/formoterol was proven because the lower limit of FEV1-change (97.5% CI) was above 90% of the efficacy of the alternative treatment. Symptoms, quality of life, treatment failures, need for reliever medication (and exacerbations during follow-up) did not differ between the groups. No safety concerns were identified. Conclusion High dose budesonide/formoterol was as effective as prednisolone plus formoterol for the ambulatory treatment of acute exacerbations in non-hospitalized COPD patients. An early increase in budesonide/formoterol dose may therefore be tried before oral corticosteroids are used. Clinical trial registration NCT00259779