Background: Asthma management may involve a step up in treatment when symptoms are not well controlled.\nWe examined whether budesonide/formoterol maintenance and reliever therapy (MRT) is as effective as higher,\nfixed-dose budesonide plus as-needed terbutaline in patients requiring step-up from Step 2 treatment (low-dose\ninhaled corticosteroids), stratified by baseline reliever use.\nMethods: A post-hoc analysis utilized data from three clinical trials of 6ââ?¬â??12 monthsââ?¬â?¢ duration. Patients aged ââ?°Â¥12 years\nwith symptomatic asthma uncontrolled despite Step 2 treatment were included. Severe exacerbation rate, lung function\nand reliever use were analysed, stratified by baseline reliever use (<1, 1ââ?¬â??2 and >2 occasions/day).\nResults: Overall, 1239 patients were included. Reductions in severe exacerbation rate with budesonide/formoterol MRT\nversus fixed-dose budesonide were similar across baseline reliever use levels, and were statistically significant in patients\nusing 1ââ?¬â??2 (42%, p = 0.01) and >2 (39%, p = 0.02) reliever occasions/day, but not <1 reliever occasion/day (35%, p = 0.11).\nBoth treatments significantly increased mean FEV1 from baseline; improvements were significantly greater for\nbudesonide/formoterol MRT in all reliever use groups. Reductions in reliever use from baseline were significantly greater\nwith budesonide/formoterol MRT versus fixed-dose budesonide in patients using 1ââ?¬â??2 and >2 reliever occasions/day\n(âË?â??0.33 and âË?â??0.74 occasions/day, respectively).\nConclusions: Treatment benefit with budesonide/formoterol MRT versus higher, fixed-dose budesonide plus short-acting\nÃ?²2-agonist was found in Step 2 patients with relatively low reliever use, supporting the proposal that budesonide/\nformoterol MRT may be useful when asthma is uncontrolled with low-dose inhaled corticosteroid.
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