What is the comparison between budesonide (corticosteroid) formoterol (long-acting beta2-agonist (LABA)) and beclomethasone (corticosteroid) formoterol (LABA) for treating asthma or Chronic Obstructive Pulmonary Disease (COPD)?

Comparison of Budesonide/Formoterol and Beclomethasone/Formoterol for Asthma and COPD

Both budesonide/formoterol and beclomethasone/formoterol combinations are equally effective for treating asthma and COPD, with similar efficacy profiles and safety outcomes. 1

Efficacy Comparison in Asthma

• Budesonide/formoterol and beclomethasone/formoterol demonstrate equivalent efficacy in improving lung function in patients with moderate-to-severe asthma, with no significant differences in morning peak expiratory flow (PEF) 1
• Both combinations significantly improve symptoms and reduce rescue medication use compared to monotherapy with inhaled corticosteroids alone 2, 3
• The fixed combination of beclomethasone/formoterol delivered via hydrofluoroalkane Modulite pressurized metered-dose inhaler (pMDI) is therapeutically equivalent to budesonide/formoterol delivered via Turbuhaler dry powder inhaler (DPI) 1
• No significant differences have been observed between the two combinations in the rate of asthma exacerbations 1

Efficacy Comparison in COPD

• In patients with severe stable COPD, beclomethasone/formoterol (400/24 μg daily) is non-inferior to budesonide/formoterol (800/24 μg daily) in improving pre-dose morning FEV₁ over 48 weeks 4
• Both combinations show similar exacerbation rates in COPD patients (0.414 exacerbations/patient/year for beclomethasone/formoterol vs. 0.423 for budesonide/formoterol) 4
• For COPD patients with high symptom burden and risk of exacerbations, ICS/LABA combinations are recommended as they reduce exacerbation frequency compared to LABA monotherapy 5

Dosing and Administration

• Budesonide/formoterol is available as a dry powder inhaler in various countries and as a pressurized metered-dose inhaler in the US 3
• Beclomethasone/formoterol is available as a hydrofluoroalkane Modulite pressurized metered-dose inhaler 1
• Both combinations can be administered twice daily for maintenance therapy 2, 1
• Budesonide/formoterol has been studied in adjustable maintenance dosing regimens, which may result in lower overall medication use while maintaining asthma control 2, 3
• Budesonide/formoterol can also be used as both maintenance and reliever therapy (SMART approach) in some countries, which has shown to reduce exacerbation rates compared to fixed-dosing regimens 3

Clinical Considerations for Asthma

• For patients with persistent asthma symptoms despite treatment with inhaled corticosteroids alone, adding a LABA (such as formoterol) is recommended 5
• Both combinations are more effective than higher doses of inhaled corticosteroids alone in improving lung function and controlling symptoms 2, 3
• Long-acting β2-agonists should never be used as monotherapy for asthma control and should always be administered in combination with inhaled corticosteroids 5

Clinical Considerations for COPD

• For COPD patients with exacerbations despite appropriate therapy with long-acting bronchodilators, ICS/LABA combinations are recommended 5
• In COPD patients at high risk of exacerbations with high symptom burden, triple therapy (LAMA/LABA/ICS) is recommended over LABA/LAMA dual therapy or ICS/LABA combination therapy to reduce mortality 5
• The choice between different ICS/LABA combinations should consider patient factors, device preferences, and medication costs, as the efficacy appears similar 4

Safety Considerations

• Both combinations have similar safety and tolerability profiles 1
• ICS/LABA combinations may increase the risk of pneumonia in COPD patients compared to LABA monotherapy 5
• For patients with COPD, guidelines recommend LABA/LAMA as primary choice over ICS/LABA due to the pneumonia risk associated with ICS 5

Clinical Pearls

• When choosing between these combinations, consider:
  • Patient preference for inhaler device (dry powder vs. pressurized metered-dose inhaler) 1
  • Dosing flexibility requirements (budesonide/formoterol offers more studied flexible dosing options) 2, 3
  • For asthma patients with mild disease, as-needed budesonide-formoterol has shown superiority to as-needed SABA alone 6
• Avoid common pitfalls:
  • Never prescribe LABA monotherapy for asthma due to safety concerns 5
  • Don't overlook the increased pneumonia risk when prescribing ICS/LABA combinations for COPD patients 5
  • Consider triple therapy for COPD patients with continued exacerbations despite dual therapy 5