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Short‐acting beta‐agonists are traditionally used to ease symptoms when people experience wheezing and breathlessness during asthma exacerbations. Formoterol is a bronchodilator that works quickly to relieve symptoms and the effect lasts longer. We are interested in whether there are any benefits or disadvantages associated with using formoterol instead of more traditional treatments to relieve symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 8, 2010

Combined formoterol and budesonide inhalers can be used for maintenance treatment of asthma and relief of symptoms. Three trials involving 5905 participants were included. We found very little evidence in relation to the use of formoterol and budesonide for relief of symptoms in people with mild asthma, but in people with more severe asthma who had suffered exacerbations in spite of regular treatment with inhaled corticosteroids, we found that reliever formoterol and budesonide compared favourably with terbutaline in reducing asthma exacerbations that required a course of oral corticosteroids. However only a small proportion of the 'severe asthma exacerbations' as defined in the trials led to hospital admissions, and no significant overall benefit has yet been shown for this outcome. In children with asthma that was not controlled with regular inhaled corticosteroids, there were fewer serious adverse events when formoterol and budesonide were used to relieve symptoms as well as for maintenance treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 21, 2009

Asthma is a common condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an irritant (an asthma trigger), the muscles around the walls of the airways tighten, the airways become narrower, and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma ‐ wheezing, coughing and difficulty in breathing. They can lead to an asthma attack or exacerbation. People can have underlying inflammation in their lungs and sticky mucus or phlegm may build up, which can further narrow the airways. There is no cure for asthma; however there are medications that allow most people to control their asthma so they can get on with daily life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 14, 2012

Asthma is a common condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an irritant (an asthma trigger), the muscles around the walls of the airways tighten, the airways become narrower, and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma ‐ wheezing, coughing and difficulty in breathing. They can lead to an asthma attack or exacerbation. People can have underlying inflammation in their lungs and sticky mucus or phlegm may build up, which can further narrow the airways. There is no cure for asthma; however there are medications that allow most people to control their asthma so they can get on with daily life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 18, 2012

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an asthma trigger, their airways become irritated and the muscles around the walls of the airways tighten so that the airways become narrower (bronchoconstriction) and the lining of the airways becomes inflamed and starts to swell. Sometimes, sticky mucus or phlegm builds up, which can further narrow the airways. These reactions cause the airways to become narrower and irritated ‐ making it difficult to breathe and leading to coughing, wheezing, shortness of breath and tightness in the chest. People with asthma are generally advised to take inhaled steroids to combat the underlying inflammation, but if asthma is still not controlled, current clinical guidelines for people with asthma recommend the introduction of an additional medication to help. A common strategy in these situations is to use a long‐acting beta‐agonists: formoterol or salmeterol. A long‐acting beta‐agonist is an inhaled drug which opens the airways (bronchodilator) making it easier to breath.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2010

People with persistent asthma often require an additional treatment to regular inhaled steroids. Some preparations of long‐acting beta‐agonists are delivered in the same inhaler device as the inhaled corticosteroids. Inhaled steroids help to treat inflammation of the airway and long‐acting beta‐agonists help the airway to relax, improving symptoms and lung function. This systematic review examined randomised controlled trials comparing two commonly available combinations administered at a fixed dose through a single inhaler, fluticasone/salmeterol and budesonide/formoterol. We included five studies which recruited 5537 people. The trials were generally well designed but only recruited adults and adolescents and not children. Participants were already taking regular inhaled steroids before the studies commenced and had mild or moderate asthma based on tests of their airway. We found that the number of people who required treatment with oral steroids and admission to hospital was similar between the treatments, but due to the statistical uncertainty of this result we could not rule out important differences in favour of either drug combination. Additional trials would enable us to draw more reliable conclusions about how well these drugs work compared with each other. We also looked at serious adverse events. Again, the results did not indicate that one combination was clearly better than the other, but again these results were imprecise so we cannot be certain. However, lung function and rescue medication use were similar between the treatments. We could not assess the relative effects of these drugs on mortality because there were so few deaths which leads to statistical uncertainty; out of the five studies, one person died. Quality of life was measured in different ways in two studies and we could not determine how the treatments compared in this respect. Further studies are needed to strengthen and better explain these findings. In particular studies which assess the effects of these therapies in children and studies which measure quality of life are a priority.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 7, 2011

We looked at previous Cochrane reviews on long‐acting beta2‐agonists and also searched for additional trials on long‐acting beta2‐agonists in children. We found a total of 21 trials involving 7318 children that provided information on the safety of formoterol or salmeterol given alone or combined with corticosteroids. We also found one trial on 156 children which directly compared formoterol to salmeterol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 17, 2012

‘Single inhaler therapy’ means that a single inhaler containing two drugs is used. One of these drugs acts quickly and is called the "reliever". The other works much more slowly and is called the "preventer". The reliever is a beta‐agonist bronchodilator, which help to open the airways and help people breathe more easily. The preventer is a steroid that controls the underlying inflammation in the lungs, which is caused by the asthma. People on 'single inhaler therapy' (SiT) have one inhaler for use every day to control their underlying inflammation and also for symptom relief. The idea behind SiT is that when people take their inhalers to reduce their shortness of breath or wheezing they will also be getting an increased dose of the steroid preventer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 30, 2013

Asthma is a disease of the lungs. Symptoms include wheezing, breathlessness and chest tightness. Two main features of asthma have been identified: underlying inflammation, which can be treated with daily steroids, and bronchoconstriction (tightening of the muscles around small tubes in the lungs), which can be treated with a beta2‐agonist to relax the muscles.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 7, 2013

Asthma is a common condition that affects the airways. When a person with asthma comes into contact with an irritant, the muscles around the walls of the airways tighten and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma—wheezing, coughing and difficulty in breathing. No cure for asthma is known; however, there are medications that allow most people to control their asthma so they can get on with daily life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 6, 2014

Patients with chronic asthma are generally treated with a 'preventer medication' to reduce the underlying airways inflammation but often require bronchodilators for their symptoms. Treatment with regular long acting Beta‐agonist bronchodilator agents, such as salmeterol (Serevent) or formoterol (Foradil, Oxis), leads to fewer asthma symptoms during the day and the night, less bronchodilator medication requirement for symptoms, better lung function measurements and better quality of life measurements compared to short acting Beta‐agonist bronchodilators such as salbutamol (Ventolin, Asmol, Airomir) or terbutaline (Bricanyl). There were no major adverse effects but there is little information on the effects in patients who do not use a 'preventer medication'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 22, 2002

This review aims to determine the effectiveness of long‐acting beta‐agonists, salmeterol or formoterol, in the treatment of COPD (emphysema/chronic bronchitis). These drugs improve airflow in the lungs, and enable people with COPD to get on with their daily activities. Twenty‐four studies (6061 participants) reported the effects of LABAs in people with COPD. People taking salmeterol 50 mcg daily do have fewer exacerbations than those on placebo, and some improvement in lung function and certain quality of life scores. The findings were not consistent enough to support a general recommendation for the use of these drugs in the group of people with COPD with minimal variation in their lung function, although there is some evidence of improvement in important outcomes and these findings require further exploration in additional trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2006

Inhalers containing corticosteroids, long‐acting beta2‐agonists or both can be used to treat severe chronic obstructive pulmonary disease (COPD). However, the benefits and harms of the two individual treatments are unclear when comparing one treatment with the other.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that causes shortness of breath and impairs quality of life. In addition, sudden worsening of symptoms (acute exacerbations) may require additional treatment or hospitalisation and may result in further impairment in quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 10, 2015

This review looks at studies that compare the regular use for at least four weeks of different types of bronchodilator medicine (long acting beta‐2 agonist medicines and ipratropium) in people with stable chronic obstructive pulmonary disease (COPD, or emphysema/chronic bronchitis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2006

Combinations of two classes of medication (long‐acting beta2‐agonists (LABAs) and inhaled corticosteroids (ICS)) in one inhaler have been developed to treat people with COPD, as this may make it easier to take the medication. Three brands of combined inhaler are currently available: budesonide/formoterol (BDF-'Symbicort'), fluticasone propionate/salmeterol (FPS-'Advair' or 'Seretide') and mometasone furoate/formoterol (MF/F-'Dulera'). Both the ICS part and the LABA component of each inhaler are aimed at reducing flare‐ups of COPD, which can be debilitating and costly. In addition, the LABA component may improve day‐to‐day symptoms such as breathlessness and exercise tolerance.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 30, 2013

The use of long‐acting ß2‐agonists (LABAs) as 'add‐on' medication to inhaled corticosteroids is recommended for poorly‐controlled asthma where asthma exacerbations may require additional treatment with oral steroids. The purpose of this review was to assess the efficacy and safety of adding long‐acting ß2‐agonists to inhaled corticosteroids in asthmatic children and adults. Based on the identified randomised trials, in people who remain symptomatic while on inhaled corticosteroids, the addition of long‐acting ß2‐agonists improves lung function and reduces the risk of asthma exacerbations compared to ongoing treatment with a similar dose of inhaled corticosteroids alone in adults. We could not find evidence of increased serious adverse events or withdrawal rates due to adverse health events with the combination of long‐acting ß2‐agonists at usual doses and inhaled corticosteroids in adults. This provides some indirect evidence, but not total reassurance, regarding the short‐ and medium‐term safety of this treatment strategy. There have not been enough children studied to assess the risks and benefits of adding LABAs in this age group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 12, 2010

A paucity of evidence is available to allow conclusions on whether combined inhaled corticosteroids (ICS)‐long‐acting beta2‐agonists (LABA) are equivalent or superior to placebo or ICS monotherapy for the treatment of stable or exacerbation (flare‐up) state bronchiectasis (Appendix 2).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 10, 2014

Chronic obstructive pulmonary disease (COPD) is a lung disease that includes the conditions chronic bronchitis and emphysema. The symptoms include breathlessness and a chronic cough. COPD is an irreversible disease that is usually brought on by airway irritants, such as smoking or inhaled dust.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 22, 2015

Tiotropium is an inhaled medication that helps open the airways (bronchodilator) and is used to manage persistent symptoms of COPD. We found seven studies including 12,223 participants that compared tiotropium with long‐acting beta2‐agonists (LABAs), which are another type of bronchodilator. This systematic review found that currently there is insufficient evidence to suggest which of these treatments provides greater long‐term benefit in quality of life. Furthermore, both treatments had similar effects on symptoms, lung function and death rates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 12, 2012

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