| 1. |
- Juniper, E F, et al.
(författare)
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Asthma quality of life during 1 year of treatment with budesonide with or without formoterol
- 1999
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Ingår i: European Respiratory Journal. - 1399-3003. ; 14:5, s. 1038-1043
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Tidskriftsartikel (refereegranskat)abstract
- The Formoterol and Corticosteroids Establishing Therapy (FACET) study has provided the first opportunity to examine the long-term effects of inhaled steroids and long-acting beta2-agonists on asthma-specific quality of life. The objectives of the present study were to: evaluate the effects of long-term (1 yr) formoterol and increasing doses of budesonide on asthma quality of life; 2) to determine whether initial improvements in quality of life are sustained when improvements in clinical indices persist; and 3) to evaluate the long-term relationship between changes in clinical indices and changes in quality of life. Of the 852 asthmatic adults enrolled, 470 from five countries participated in this quality of life evaluation. After a 4-week run-in on 1,600 microg budesonide, patients were randomized to either 200 microg (Bud200) or 800 microg budesonide (Bud800) in combination with either 24 microg formoterol (F) or placebo daily for 1 yr. The Asthma Quality of Life Questionnaire (AQLQ) was completed and conventional clinical indices measured at enrolment and randomization and on seven occasions during the following 12 months. During the run-in, there was an improvement in AQLQ score (changes (delta) in overall score approximately 0.50; p<0.0001). After randomization, there was a further improvement in the Bud800+F group (delta=0.21; p=0.028). One month post-randomization, improvements in all groups stabilized and were sustained throughout the 12 months in a pattern very similar to that observed for the conventional clinical indices. The correlation of individual patient changes in clinical indices and changes in AQLQ score during the 12-month randomized period were weak to moderate (maximum r=0.51). Improvements in quality of life, which were greatest in the 800 microg budesonide plus 24 microg formoterol group, were sustained throughout the 12 months in a similar manner to the clinical indices. Long-term changes in conventional clinical indices cannot be used to predict the effect of treatment on individual patient experience.
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| 2. |
- Tattersfield, A E, et al.
(författare)
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Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group
- 1999
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1535-4970. ; 160:2, s. 594-599
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Tidskriftsartikel (refereegranskat)abstract
- The identification, prevention, and prompt treatment of exacerbations are major objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue beta-agonists during the 425 severe exacerbations that occurred during a 12-mo parallel group study (FACET) in which low and high doses of budesonide with and without formoterol were compared in patients with asthma. Oral corticosteroids were prescribed for severe exacerbations, the main study end point, defined as the need for a course of oral corticosteroids (n = 311) or a reduction in morning PEF of > 30% on two consecutive days. PEF, symptoms, and bronchodilator use over the 14 d before and after the exacerbation were obtained from diary cards. Exacerbations were characterized by a gradual fall in PEF over several days, followed by more rapid changes over 2 to 3 d; an increase in symptoms and rescue beta-agonist use occurred in parallel, and both the severity and time course of the changes were similar in all treatment groups. Exacerbations identified by the need for oral corticosteroids were associated with more symptoms and smaller changes in PEF than those identified on the basis of PEF criteria. Female sex was the main patient characteristic associated with an increased risk of having a severe exacerbation. Exacerbations may be characterized predominantly by change in symptoms or change in PEF, but the pattern was not affected by the dose of inhaled corticosteroid or by whether the patient was taking formoterol.
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| 3. |
- Lötvall, Jan, 1956, et al.
(författare)
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Targeting drugs to the airways by different inhalation devices: role of deposition characteristics.
- 1999
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Ingår i: BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy. - 1173-8804. ; 12:4, s. 279-89
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Tidskriftsartikel (refereegranskat)abstract
- Inhalation therapy has greatly improved the treatment of asthma over the last decades. In recent years, inhalation technology has further optimised the local deposition of inhaled antiasthma drugs. Some studies have suggested improved clinical efficacy, and possibly tolerability, of drugs given with modern dry powder inhalers. In particular, the inhalers Turbuhaler((R)) and Diskus((R)) are now commonly used to treat asthma. This review critically evaluates studies comparing the clinical efficacy of antiasthma drugs delivered by available powder inhalers or by pressurised metered-dose inhalers (pMDI), focusing on comparisons of the same drug given by different inhalers. Results differ among studies, in part because of the inclusion of different patient groups (ideally the patients should have reversible airways obstruction) and use of unequal doses or artificial inhalation patterns that may not be optimal for one of the devices. Furthermore, the use of plastic spacers with pMDIs may affect drug delivery.
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