Combination therapy in asthma: a review

Asthma can be defined as a chronic inflammatory disease of the airways that is reversible either spontaneously or by treatment. Despite the exponential increase in asthma research, the prevalence of asthma is on the increase, especially in children and young adults in the western societies. Inhaled therapies are the mainstay of asthma management. This is often in the form of combined therapy using two drugs in a single device to ensure adjustable maintenance dosing.

Relevant literature was reviewed using available medical journals, MEDLINE, Pubmed and Science direct via the Internet. The key words employed were: asthma, combination therapy, long acting beta agonists and corticosteroids. British Thoracic Society and The National Heart, Lung and Blood Institute websites were also used in sourcing information.

Several studies have shown that combination therapy using long acting beta agonists (LABA) and inhaled corticosteroids (ICS) in a single inhaler device confers complementary and synergistic effect in the management of asthma. It further improves patient compliance and reduces the complexity of treatment and morbidity associated with the disease. Recent studies have shown the combination therapy to serve not only as maintenance but also a reliever therapy with same efficacy as the short acting beta agonists (SABA).

This review was able to show the advantages of using combination therapy in asthma patients. This has been a subject of review at both national and international levels as there is no single medication that is effective against both the inflammatory and bronchoconstrictive components of this disorder. Recent studies have shown that Budesonide/formoterol in a single inhaler has been found to be effective maintenance and reliever agent in both adults and children. It has also been found to be safe and more efficacious than fixed-dosing. In addition to convenience and patient compliance, combination devices also help towards individualized approach to asthma management and reduce the complexity of treatment; this appears ideal for adoption by the primary care physician with a view for the patient to effectively achieve control of his own condition.