Therapeutic strategies to reduce asthma exacerbations

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Presentation transcript:

Therapeutic strategies to reduce asthma exacerbations Paul M. O’Byrne, MB, FRCP(C), FRSC Journal of Allergy and Clinical Immunology Volume 128, Issue 2, Pages 257-263 (August 2011) DOI: 10.1016/j.jaci.2011.03.035 Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Time of onset of the severe asthma exacerbations identified in the Formoterol and Corticosteroids Establishing Therapystudy.7 Asthma symptom scores increased over 5 to 7 days before the exacerbations were recognized by the managing health care professional and treatment with oral corticosteroids was started (dashed line). The exacerbation resolved over 5 to 7 days on treatment. BUD, Budesonide; F, formoterol. Redrawn from data in Tattersfield et al.6 Journal of Allergy and Clinical Immunology 2011 128, 257-263DOI: (10.1016/j.jaci.2011.03.035) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Number of severe asthma exacerbations (per patient per year) in the Formoterol and Corticosteroids Establishing Therapy study.7 A 4-fold increase in the ICS budesonide alone reduced severe asthma exacerbations by 50%. The addition of the LABA formoterol further reduced severe exacerbations when added to either the low or higher dose of budesonide. BUD, Budesonide; F, formoterol. Reproduced with permission from Pauwels et al.7 Journal of Allergy and Clinical Immunology 2011 128, 257-263DOI: (10.1016/j.jaci.2011.03.035) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Number of severe asthma exacerbations (per patient per year) in the Optimal Management of Asthma study.18 The study consisted of 2 populations: group A, who were steroid naive at the time of study enrollment, and group B, who were already receiving low-dose ICS treatment at the time of study enrollment. In group A low-dose budesonide alone markedly reduced severe exacerbations, whereas in group B doubling the dose of budesonide alone did not reduce severe exacerbations, but adding the LABA formoterol did reduce severe exacerbation risk. BUD, Budesonide; F, formoterol. Redrawn from data in O’Byrne et al.18 Journal of Allergy and Clinical Immunology 2011 128, 257-263DOI: (10.1016/j.jaci.2011.03.035) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Kaplan-Meier analysis of the proportion of patients without an asthma exacerbation. Both patient groups had a structured reduction of maintenance oral prednisone during the study. The mepolizumab-treated patients did not experience an eosinophilic asthma exacerbation during the study, whereas this occurred in 9 of 10 patients receiving placebo. Reproduced with permission from Nair et al.31 Journal of Allergy and Clinical Immunology 2011 128, 257-263DOI: (10.1016/j.jaci.2011.03.035) Copyright © 2011 American Academy of Allergy, Asthma & Immunology Terms and Conditions