Objective: To examine the efficacy of the maintenance and reliever (M+R) approach in the treatment of asthma exacerbations.
Data sources: PubMed, MEDLINE, and Cochrane database searches using the key words formoterol and budesonide, dynamic dosing, adjustable dosing, and M+R therapy.
Study selection: Articles were selected based on their relevance to the topic of this review.
Results: Several studies have examined dynamic dosing of the long-acting beta-agonist 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.
Conclusions: Although many of the data regarding this approach are positive, not all the studies have demonstrated efficacy. It is hoped that future non-pharmaceutical company-sponsored research will clarify this issue and, should efficacy be confirmed, shed light on the mechanism of action.