Adjustable maintenance dosing with budesonide/formoterol in a single inhaler - efficacy and safety

Summary Asthma guidelines support adjustable maintenance dosing and the use of guided self-management for long-term asthma management and advocate the use of inhaled corticosteroids and long-acting β2-agonists to control symptoms. In this context, budesonide/formoterol in a single inhaler may be used with either a fixed-dosing or adjustable maintenance dosing treatment regimen. Eight randomised studies compared the efficacy and tolerability of budesonide/formoterol adjustable maintenance dosing (one to two inhalations bid with a temporary step-up to four inhalations bid maximum) with fixed-dosing (two inhalations bid). In three studies (≥6 months in duration), a reduced incidence of exacerbations was reported with adjustable maintenance dosing compared with fixed-dosing. In all studies, adjustable maintenance dosing reduced the mean number of inhalations of budesonide/formoterol per patient per day compared with fixed-dosing while maintaining or improving asthma control. Adjustable maintenance dosing with budesonide/formoterol is well tolerated and has proven to be a more effective treatment strategy for asthma management, despite using less amount of drug compared with fixed-dosing.