how effective and safe budesonide/formoterol are comparison with the salbutamol in the treatment of acute asthma.

how effective and safe budesonide/formoterol are comparison with the salbutamol in the treatment of acute asthma.

Author:- Aalam Muntazim
(Karaganda Medical University)
Aim:
Make awareness about not treat Acute Asthma with SABA alone.
Abstract:
There's no longer recommends treating grown-ups adolescents with asthma with SABA alone. rather, they should admit symptom- driven {mild asthma} or a diurnal corticosteroid containing inhaler, to reduce threat of severe exacerbations.

Keywords: Short- acting β2- agonists, Inhaled corticosteroids, long- acting β2- agonists, GINA 2019, methacholine
Overview 
Introduction
SABA (Short- acting β2- agonists) are presently the gold standard for relief of acute asthma symptoms in all rigidness of asthma. ICS (Inhaled corticosteroids) are the recommended as a remedy for the most of cases with patient asthma because of their anti-inflammatory impact. In cases with patient asthma, where low doses of ICS alone don't give optimal control, the combination of ICS and (LABA) long- acting β2- agonists is more effective than adding the dose of ICS. 
Combination inhalers containing an ICS and a LABA are a fairly new addition to the pharmacological operation of asthma. presently, there are two single- inhaler combination products on the request budesonide/ formoterol and salmeterol/ fluticasone.

In 2019, GINA 
It is an comprehensive review on the adverse issues of treatment with SABA-only and the impact on asthma exacerbations and deaths of any form of ICS in mild asthma, and resolved that there was now sufficient information to recommend that grown-ups and adolescents with asthma shouldn't be treated with SABA alone. rather, they should have either symptom- driven(mild asthma) or diurnal ICS- containing treatment, to decrease their threat of serious exacerbations. Several treatment options for achieving this are recommended in the GINA 2019 report.

Step 1 is for cases with symptoms lower than twice a month. Then, no direct substantiation is available, but the explanation for the “ favored ” controller option of as- demanded ICS – formoterol, or for having ICS whenever SABA is taken, is taken as circular substantiation from the corresponding Step 2 studies. 
In formulating the Step 1 recommendations, high significance was given to stopping of severe exacerbations, and to avoidance of contradictions in asthma messaging between Step 1 and Step 2. Regular ICS isn't recommended for Step 1, because it was considered extremely doubtful that cases with similar occasional symptoms would be prepared to take a diurnal treatment.
Why not treat with SABA alone?
Inhaled SABA has been first- line treatment for asthma for the 50 years
Initially Asthma was thought as a complaint of bronchoconstriction
SABA's role reinforced by rapid-relief of asthmatic symptoms and low cost. 
Regular use of SABA, indeed for 1 – 2 weeks, is associated with increasing in the cases of AHR, and reduces the effect of bronchodilator, increases the antipathetic response, also increases eosinophils. 
Can lead to a violent cycle encouraging overuse. 
Overuse of SABA increases cases of exacerbations and mortality.
Basically needed low dose ICS-formoterol in mild asthma...!
COMPARED WITH AS-NEEDED SABA...!
The risk of severe exacerbations was decreased by 60–64%.
The Comparison of formoterol, salbutamol and salmeterol in severe bronchoconstriction induced by methacholine : A clinical research..
The initiation of the bronchodilating effect of formoterol( 12 mg by Turbuhaler) was compared with that of salmetarol( 50 microg by diskhaler) and sabutamol( 50 microg by turbuhaler) and placebo(a substance which has no therapeutic effect, but used as a control in testing various new drugs and it was also seen that placebo improves the symptoms but does not lessens the disease) in methacholine convinced severe bronchoconstriction. 
Seventeen subjects with mild- to-moderate asthma completed this randomized, double-blind, cross_over, double_dummy study. 
On four days of study, The baseline of forced expiratory volume in one alternate( FEV1) was recorded and then the subjects were challenged with methacholine until FEV1 fell by at almost 30%.
Right after, the medicines which are mentioned above were gobbled(inhaled) and lung function was assessed for 60 min.
Then Geometric mean time for FEV1 to return to 85% was 7.2 min with formoterol, 6.5 min with salbutamol, 14.1 min with salmeterol and 34.7 min with placebo( p = 0.0001, overall ANOVA). The difference between formoterol and salmeterol was statistically significant( p = 0.01); there was no difference between formoterol and salbutamol( p = 0.69).
Conclusions:
Formoterol( Oxis) Turbuhaler may have a further favourable rate between local and systemic effect than salbutamol. The clinical recrimination would be that systemically intermediated side-effects of gobbled(inhaled) formoterol may be less pronounced than with an equiveffective bronchodilating dose of gobbled salbutamol. 
As-demanded ICS+formoterol offers a therapeutical alternative to the maintanence of low- dose ICS plus SABA in asthma and may be the more favored option when preventing of severe exacerbation is the primary thought of treatment. 
methacholine- induced severe bronchoconstriction is reversed by formeterol as salbutamol and further more than salmeterol. Classifying beta2- agonists as" fast" and" slow" amusement may be supplemental to" short" and" long" amusement.

References:

Pulmonary Pharmacology & Therapeutics
Volume 19, Issue 2, April 2006,
Author panelV.M. Balanag a, F. Yunus b, P.-C. Yang c, C. Jorup d. 
Helen K. Reddel, J. Mark FitzGerald, Eric D. Bateman, Leonard B. Bacharier, Allan Becker, Guy Brusselle, Roland Buhl, Alvaro A. Cruz, Louise Fleming, Hiromasa Inoue, Fanny Wai-san Ko, Jerry A. Krishnan, Mark L. Levy, Jiangtao Lin, Søren E. Pedersen, Aziz Sheikh, Arzu Yorgancioglu, Louis-Philippe Boulet
European Respiratory Journal 2019 53: 1901046; DOI: 10.1183/13993003.01046-2019

Gina 2019

Politiek MJ, Boorsma M, Aalbers R. Comparison of formoterol, salbutamol and salmeterol in methacholine-induced severe bronchoconstriction. Eur Respir J. 1999 May;13(5):988-92. doi: 10.1034/j.1399-3003.1999.13e10.x. PMID: 10414394.