Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Combination asthma treatments are equivalent

The Cochrane Library has published a review comparing combination fluticasone and salmeterol (Seretide®) versus combination budesonide and formoterol (Symbicort®) for chronic asthma.

The review aimed to assess the efficacy of each treatment in terms of asthma control, safety and lung function. Any randomised controlled trial comparing the two treatments was included provided the study ran for a minimum of 12 weeks and was not a crossover study. Five studies were included in the analysis with data from 5,537 participants.

Primary outcome measures were exacerbation requiring oral steroids, exacerbation requiring hospital admission and serious adverse reactions. There was no difference in any of these outcomes. The authors note the wide confidence interval and state that the findings "do not exclude clinically important differences between treatments". They conclude that additional trials are justified to better determine any differences.

Action: It would seem that these two combination therapies are equivalent in terms of efficacy and safety. Until differences are demonstrated the choice of appropriate treatment should be based on patient factors and acquisition cost.

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