geoffrey modest medical blogs

  a recent systematic review and meta-analysis compared short-acting β agonists (SABA) alone with SABA combined with inhaled corticosteroids (ICS), and with the fast-onset, long-acting β agonist (LABA) formoterol combined with ICS for asthma, finding that a SABA alone was the least effective (see   asthma best reliever rx JAMA2024  in dropbox, or doi:10.1001/jama.2024.22700) Details : -- 27 randomized clinical trials with 50,496 adult and pediatric patients treated in outpatient settings were included in this network meta-analysis, with 2 studies done just in pediatric patients aged <19yo  -- here are the comparisons in this network meta-analysis; the size of the lines and circles represent the numbers of RCTs and patients in the comparisons (82% of these comparisons were considered to have a low overall risk of bias): -- mean age 41.0 years; 20,288 male (40%) -- formoterol was the long-acting β agonist (LABA, alone or combined with an ICS, inhaled corticoste...

  A recent article confirmed the superiority of prescribing budesonide/formoterol (eg symbicort, and its ilk) as both the maintenance and the rescue inhaler, in a Korean real-world study (see  asthma symbicort as maint and rescue best JAlerCLinImmunPractice2022  in dropbox, or  doi.org/10.1016/j.jaip.2022.06.009   Brief background: there were 2 pivotal studies (SYGMA1 and SYGMA2) that set in motion a profound change in treating adult asthmatic patients, codified in the quite impressive global GINA recommendations of 2019:  http://gmodestmedblogs.blogspot.com/2019/10/new-and-improved-asthma-guidelines.html  . see below for more   Details : -- retrospective data analysis from the medical records of the Ajou University Medical Center in Korea of adult asthmatics, from 2008 to 2021 -- patients were divided into and propensity score-matched for MART (Maintenance and Reliever Therapy, using inhaled corticosteroid with formoterol) versus non-MART (using ...