Self-titration of inhaled corticosteroid and β2-agonist in response to symptoms in mild asthma: a pre-specified analysis from the PRACTICAL randomised controlled trial. Baggott, C., Hardy, J., Sparks, J., Holliday, M., Hall, D., Vohlidkova, A., Hancox, R. J., Weatherall, M., Fingleton, J., & Beasley, R. European Respiratory Journal, 56(4):2000170, October, 2020. Number: 4
Self-titration of inhaled corticosteroid and β2-agonist in response to symptoms in mild asthma: a pre-specified analysis from the PRACTICAL randomised controlled trial [link]Paper  doi  abstract   bibtex   
Introduction In mild asthma, as-needed budesonide–formoterol is superior or noninferior to maintenance budesonide plus as-needed short-acting β 2 -agonist in reducing severe exacerbations. In this pre-specified analysis, we investigated patterns of inhaled corticosteroid (ICS) and β 2 -agonist use in PRACTICAL, a randomised controlled trial. Methods Participants were randomised 1:1 to as-needed budesonide–formoterol (200/6 μg Turbuhaler, one actuation) or maintenance budesonide (200 μg Turbuhaler, one actuation twice a day) with as-needed terbutaline (250 μg, two actuations) for 52 weeks. 110 participants had electronic monitors attached to their study inhalers which captured the time and date of every actuation. Key outcome measures were patterns of ICS and β 2 -agonist use. One actuation of budesonide–formoterol was considered to be an equivalent bronchodilator dose as two actuations of terbutaline. Results Participants randomised to as-needed budesonide–formoterol had more days with no ICS use compared with maintenance budesonide (median total days of no use 156 versus 22 days, respectively), lower median daily budesonide dose (164 versus 328 μg, respectively) and a greater median number of days of ≥4 budesonide actuations (4 versus 1 days, respectively). Participants randomised to as-needed budesonide–formoterol took higher equivalent doses of β 2 -agonist both overall (median number of actuations 0.8 versus 0.3 per day, respectively) and in response to worsening asthma (total number of “overuse days” of \textgreater8 or \textgreater16 actuations of budesonide–formoterol or terbutaline 33 versus 10 days, respectively). Conclusions The timing of ICS dose when self-titrated to β 2 -agonist use is more important than total ICS dose in reducing severe exacerbation risk in mild asthma, when associated with greater overall use of as-needed β 2 -agonist.
@article{baggott_self-titration_2020,
	title = {Self-titration of inhaled corticosteroid and β2-agonist in response to symptoms in mild asthma: a pre-specified analysis from the {PRACTICAL} randomised controlled trial},
	volume = {56},
	issn = {0903-1936, 1399-3003},
	shorttitle = {Self-titration of inhaled corticosteroid and β $_{\textrm{2}}$ -agonist in response to symptoms in mild asthma},
	url = {http://erj.ersjournals.com/lookup/doi/10.1183/13993003.00170-2020},
	doi = {10.1183/13993003.00170-2020},
	abstract = {Introduction
              
                In mild asthma, as-needed budesonide–formoterol is superior or noninferior to maintenance budesonide plus as-needed short-acting β
                2
                -agonist in reducing severe exacerbations. In this pre-specified analysis, we investigated patterns of inhaled corticosteroid (ICS) and β
                2
                -agonist use in PRACTICAL, a randomised controlled trial.
              
            
            
              Methods
              
                Participants were randomised 1:1 to as-needed budesonide–formoterol (200/6 μg Turbuhaler, one actuation) or maintenance budesonide (200 μg Turbuhaler, one actuation twice a day) with as-needed terbutaline (250 μg, two actuations) for 52 weeks. 110 participants had electronic monitors attached to their study inhalers which captured the time and date of every actuation. Key outcome measures were patterns of ICS and β
                2
                -agonist use. One actuation of budesonide–formoterol was considered to be an equivalent bronchodilator dose as two actuations of terbutaline.
              
            
            
              Results
              
                Participants randomised to as-needed budesonide–formoterol had more days with no ICS use compared with maintenance budesonide (median total days of no use 156
                versus
                22 days, respectively), lower median daily budesonide dose (164
                versus
                328 μg, respectively) and a greater median number of days of ≥4 budesonide actuations (4
                versus
                1 days, respectively). Participants randomised to as-needed budesonide–formoterol took higher equivalent doses of β
                2
                -agonist both overall (median number of actuations 0.8
                versus
                0.3 per day, respectively) and in response to worsening asthma (total number of “overuse days” of {\textgreater}8 or {\textgreater}16 actuations of budesonide–formoterol or terbutaline 33
                versus
                10 days, respectively).
              
            
            
              Conclusions
              
                The timing of ICS dose when self-titrated to β
                2
                -agonist use is more important than total ICS dose in reducing severe exacerbation risk in mild asthma, when associated with greater overall use of as-needed β
                2
                -agonist.},
	language = {en},
	number = {4},
	urldate = {2020-10-13},
	journal = {European Respiratory Journal},
	author = {Baggott, Christina and Hardy, Jo and Sparks, Jenny and Holliday, Mark and Hall, Daniela and Vohlidkova, Alexandra and Hancox, Robert J. and Weatherall, Mark and Fingleton, James and Beasley, Richard},
	month = oct,
	year = {2020},
	note = {Number: 4},
	pages = {2000170},
}
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