Fluticasone 50micrograms/dose / Salmeterol 25micrograms/dose inhaler CFC free

Background/objectiveTo compare the efficacy of budesonide/formoterol (BF) versus fluticasone/salmeterol (FS) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD).MethodsThe PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies comparing BF versus FS in the treatment of COPD from inception to July 17, 2023. Outcomes, including exacerbations, hospitalizations, pneumonia, emergency department (ED) visits for COPD, length of hospitalization, and number of exacerbations, were compared using risk ratio (RR) with corresponding 95% confidence interval (CI) or weighted mean difference (WMD) with 95% CI. All statistical analyses were performed using Stata version 12.0.ResultsTen studies comprising a total of 136,369 participants were included. Compared with those treated with FS, patients with COPD treated with BF experienced a reduced number of exacerbations (RR 0.91 [95% CI 0.83-1.00]; p = 0.040), hospitalizations (RR 0.77 [95% CI 0.67-0.88]; p p = 0.05). However, no significant difference was observed between BF and FS in terms of ED visits for COPD (RR 0.87 [95% CI 0.69-1.10]; p = 0.243), length of hospitalization (WMD -0.18 [95% CI -0.62-0.27]; p = 0.437), and number of exacerbations (WMD -0.06 [95% CI -0.28-0.16]; p = 0.602). Notably, no significant heterogeneity was noted in length of hospitalization between the two groups, whereas clear heterogeneity was observed in other outcomes (I2 > 50%, p ConclusionCompared with FS, BF therapy appears to be a more promising treatment strategy for patients with moderate-to-severe COPD; however, this should be verified in further high-quality studies.

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Recent literature has shown that triple therapy is more effective than dual therapy for individuals with uncontrolled asthma. However, the comparative efficacy between different triple therapies remains unclear. The objective of this study was to determine the comparative efficacy of extra-fine single-inhaler medium-dose (MD) or high-dose (HD) of beclometasone/formoterol/glycopyrronium bromide (BDP/FOR/GLY) compared to other triple therapies in patients whose asthma remains uncontrolled with MD or HD inhaled corticosteroids and long-acting β2-agonists. A systematic literature review identified randomized control trials on adult patients with uncontrolled asthma. Two separate networks were constructed according to patients' previous inhaled-corticosteroid dosage. Network meta-analyses evaluated severe and moderate-to-severe exacerbations, pre-dose forced expiratory volume, and asthma control questionnaire responses at 52 (± 3) weeks. Among single-inhaler triple therapies, MD BDP/FOR/GLY significantly reduced the risk of severe exacerbations (RR [95% CrI] compared to MD fluticasone/umeclidinium/vilanterol: 0.65 [0.49, 0.89]), while HD BDP/FOR/GLY demonstrated an improved trend in reducing severe and moderate-to-severe exacerbations versus HD indacaterol acetate/glycopyrronium bromide/mometasone, fluticasone/umeclidinium/vilanterol, and salmeterol/fluticasone + tiotropium. HD BDP/FOR/GLY and HD BDP/FOR + tiotropium did not differ significantly. Compared to relevant single-inhaler triple therapies, MD and HD BDP/FOR/GLY are associated with a significant benefit or trend for improvement in terms of reducing the rate of severe and moderate-to-severe exacerbations.

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Background/Objectives: Asthma's preventable burden is heavily driven by severe exacerbations (SE). Replacing standalone short-acting β2-agonists (SABAs), which risk reducing patient tolerance, with inhaled corticosteroid/long-acting β2-agonist combinations optimizes care through maintenance, reliever, and maintenance-and-reliever therapy (MART). This systematic review and meta-analysis evaluated the efficacy, effectiveness, and safety of Budesonide/Formoterol (B/F). Methods: PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) through May 15, 2026. Bias was assessed via the Cochrane Risk of Bias tool version 2 (RoB 2) and the Risk ff Bias in Non-randomized Studies of Interventions (ROBINS-I) version 2.0. Primary outcomes (time to first SE, annual SE rate) were pooled using a random-effects meta-analysis, yielding hazard ratios (HRs) and rate ratios (RRs). Results: We included 19 studies (15 RCTs, 4 non-RCTs) comprising 104,600 patients (primarily aged ≥12 years with mild-to-severe asthma). Most RCTs had a low risk of bias, whereas the non-RCTs had a high risk of bias. B/F MART significantly delayed the first SE and reduced annual rates versus Budesonide + SABA (HR = 0.57; RR = 0.55), B/F + SABA (HR = 0.62; RR = 0.58), and Fluticasone/Salmeterol + SABA (HR = 0.75; RR = 0.72). As-needed B/F reduced first SE hazard and annual rates versus SABA alone (HR = 0.43; RR = 0.42). Compared with Budesonide + SABA, it delayed the first SE (HR = 0.85) but showed non-significant rate reductions (RR = 0.90). Adverse events were balanced between groups over 12-52 weeks. Conclusions: B/F MART demonstrates high efficacy in mitigating the risk of the first SE. However, limited trial data leave the evidence for maintenance or reliever regimens controversial. Across all regimens, B/F is well-tolerated within 6 to 12 months.

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BackgroundModerate to severe asthma poses significant health and economic challenges in South Africa (SA), with varying asthma treatment costs. Inhaled corticosteroids/long-acting beta-2-agonists remain the cornerstone of asthma management. However, cost comparisons between fluticasone/salmeterol (FP/salm) and budesonide/formoterol (bud/form) as maintenance and reliever therapy (MART) are limited in low- and middle-income settings.ObjectivesTo compare the direct treatment costs of regular FP/salm plus as-needed short-acting beta-2-agonist (SABA) with bud/form MART in the SA public sector.MethodsA comparative cost analysis was conducted from the SA public health sector perspective. Costs from the National Department of Health pharmaceutical tender and Uniform Patient Fee Schedule, and clinical effectiveness data on severe exacerbations avoided from three randomised controlled trials (AHEAD, COMPASS, COSMOS), informed annual per-patient costs. Univariate sensitivity analyses assessed the robustness of the findings.ResultsAnnual direct per-patient treatment costs for bud/form MART were probably comparable to FP/salm plus as-needed SABA in COMPASS and COSMOS (USD145.84 and USD157.81). In the AHEAD study, a higher-dose bud/form MART regimen was more expensive (USD149.14 v. USD122.65). On average across studies, FP/salm was 0.58% less expensive. Medication costs were the primary cost driver, with variation in bud/form 160/4.5 µg pricing significantly influencing overall cost outcomes.ConclusionIn SA's public sector, FP/salm plus as-needed SABA is comparable to bud/form MART for moderate to severe asthma in terms of cost. Bud/form's price sensitivity suggests potential for improved procurement. Future research should integrate real-world data, include indirect costs, and assess full-spectrum asthma management to inform efficient, equitable policy and evaluate economic impact.Study synopsisWhat the study adds. This study compares the direct costs of fluticasone/salmeterol (FP/salm) plus as-needed short-acting beta-2-agonist (SABA) v. budesonide/formoterol (bud/form) maintenance and reliever therapy (MART) for moderate to severe asthma, using South African (SA) public sector data. Findings address an evidence gap for cost-effective asthma care in low- to middle-income countries, where high mortality and SABA overuse require urgent, context-specific treatment optimisation.Implications of the findings. The research findings suggest that currently bud/form MART is comparably priced to standard care with FP/salm plus as-needed SABA in SA's public sector. Bud/form's price sensitivity presents opportunities for strategic procurement. However, further comprehensive real-world economic evaluations across all asthma severities remain essential to guide evidence-informed, context specific policy decisions.

Abstract licence: CC BY-NC