"Maintenance and reliever" (M+R) approach to asthma control

The authors examined the efficacy of the maintenance and reliever (M+R) approach in the treatment of asthma exacerbations by database searches using the key words formoterol and budesonide, dynamic dosing, adjustable dosing, and M+R therapy.

Several studies have examined dynamic dosing of the long-acting beta-agonist (LABA) formoterol combined with budesonide in the treatment of asthma. Most of these studies have shown reductions in asthma exacerbations. Although obvious concern arises regarding increase in dose of the long-acting beta-agonist component, no significant signal of morbidity or mortality has been seen.

Potential concerns regarding the studies performed thus far include the fact that all have been sponsored by the pharmaceutical industry and have required beta-agonist response as an inclusion criterion.

Although many of the data regarding this approach are positive, not all the studies have demonstrated efficacy.

Is the maintenance and reliever approach the answer? Oppenheimer JJ, Peters SP. Ann Allergy Asthma Immunol. 2010 Feb;104(2):112-7.
Image source: Combination formulation containing budesonide and formoterol - unopened Symbicort Turbuhaler (left) and opened (middle and right), Wikipedia, public domain.

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