Hur effektiv samt säker ICS/LABA är jämfört med SABA vid astma : En litteraturstudie om skov, lungfunktion och säkerhet vid astmabehandling

Sammanfattning

Asthma is a chronic inflammatory airway disease characterized by variable airflowobstruction and airway hyperresponsiveness. Traditional asthma rescue therapy relies onshort acting beta 2 agonist (SABA), such as albuterol (salbutamol), which provide rapidsymptom relief but fail to address underlying inflammation and are associated with anincreased risk of severe exacerbations upon overuse. This necessitated the developmentof combination inhalers providing both bronchodilator and antiinflammatory effects.The objective was to evaluate the efficacy and safety of new combination regimensincorporating an inhaled corticosteroid (ICS) e.g budesonide, with a bronchodilator(albuterol or formoterol) compared to SABA monotherapy in patients with mild tosevere asthma.The analysis synthesized results from five key clinical trials: MANDALA (Article 1),DENALI (Article 2), Kearns et al. (Article 3), Beasley et al. (Article 4), and Rohn et al.(Article 5), focusing on primary and secondary outcomes related to exacerbation rate,lung function (FEV1, PEF), inflammation (FeNO) and safety profiles.The results were that the combination therapies demonstrated significant superiorityover SABA monotherapy in key clinical outcomes:Exacerbation reduction: In patients with uncontrolled moderate to severe asthma, thehigh dose albuterol-budesonid fixed dose combination used as needed significantlyreduces the risk of the first severe asthma exacerbation by 26% compared to albuterolalone (MANDALA trial). For mild asthmatics, budesonide/formoterol used as neededreduced annual exacerbation frequency by 51% compared to SABA monotherapy(Beasley et al., 2019)Lung function and anti-inflammatory effect: The DENALI trial confirmed that bothalbuterol and budesonide independently contribute to improved lung function with thecombination inhaler. Budesonide/formoterol provided more sustained bronchodilationthan repeated doses of salbutamol. ICS containing regimens effectively reduced theinflammation marker FeNO.Budesonide-formeterol as needed provided protection comparable to maintenance ICSbut with significantly lower total daily steroid exposure.Salbutamol monotherapy regimens were associated with a higher incidence of certainside effects, including increased cardiovascular effects and lowering of serumpotassium. The study Rohn et al. (2023) cautioned that the SABA+ICS+LABA (long acting betaagonist) regimen, while improving lung function, was associated with a sharplyincreased risk of severe exacerbations during pregnancy in the second trimester.The findings strongly support the implementation of anti-inflammatory relief strategies.Combination treatments, particularly those integrating ICS like budesonide andformeterol, are effective and safe alternatives to SABA monotherapy, significantlyreducing the risk of asthma exacerbations and improving overall asthma control bysimultaneously addressing both bronchodilation and underlying inflammation. Thissupports a potential shift in treatment paradigms towards inflammation-focused rescuemedication.