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Prn Budesonide/Formoterol Versus Regular Budesonide/Formoterol Plus Prn Terbutaline in Mild-Moderate Asthma

Information source: Universitŕ degli Studi di Ferrara
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Asthma

Intervention: budesonide/formoterol combination (PRN) (Drug); budesonide/formoterol combination (Drug); placebo (Drug); terbutaline (Drug)

Phase: Phase 3

Status: Completed

Sponsored by: Universitŕ degli Studi di Ferrara

Official(s) and/or principal investigator(s):
Alberto Papi, MD, Principal Investigator, Affiliation: UniversitĂ  degli Studi di Ferrara


Study No. 001 about Budesonide/Formoterol use in ASthMA sponsored by Agenzia Italiana del FArmaco (Italian Drug Agency) (AIFA-ASMA-BF-001) The aim of the study is to verify whether asthma not controlled by low doses inhaled corticosteroids, thus in need for step up therapy, can be equally controlled by guidelines recommended regular bid treatment with long acting beta agonist/inhaled corticosteroid (ICS/LABA) combination or the symptom driven use of an ICS/LABA combination in the absence of maintenance therapy. The study is designed to be able to evaluate the non inferiority of regular placebo plus prn inhaled budesonide/formoterol (experimental treatment) versus regular, twice daily 160/4. 5 mcg inhaled budesonide/formoterol combination plus prn inhaled terbutaline (guidelines recommended treatment).

Clinical Details

Official title: As Needed Budesonide/Formoterol Combination Versus Regular Budesonide/Formoterol Combination Plus as Needed Terbutaline in Mild-Moderate Persistent Asthma

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Primary outcome: comparison between groups of the relative risk for treatment failure

Secondary outcome:

number of treatment failures

time to first treatment failure

differences between groups of lung function parameters, quality of life, symptoms score, use of as needed medication, adverse events

Detailed description: Asthma is a problem worldwide, with an estimated 300 million affected individuals. There is evidence that asthma prevalence has been increasing in the last decades in some countries, including Italy. Analyses of the cost of asthma lead to conclude that the burden of the disease depend on the extent to which exacerbations are avoided since emergency treatment is more expensive than regular treatment. Based on solid evidence, international guidelines recommend regular treatment with low dose ICS for mild persistent asthma and treatment with combination therapy [low dose ICS plus long-acting beta2-agonists (LABA)] for patients with asthma not controlled by low doses ICS alone. Recent studies have undermined the axiom that treatment with ICS must be regular to achieve and maintain asthma control, as equivalent control has been obtained either with prn use of an inhaled combination of a short acting beta2 agonist (SABA) and an ICS, or with a short course of 10 days high dose ICS at the start of exacerbations. In moderate-severe asthma regularly treated with inhaled ICS/LABA combination, the symptom-driven use of the same inhaled ICS/LABA combination as reliever is superior to the symptom-driven use of SABA or LABA alone.


Minimum age: 18 Years. Maximum age: 65 Years. Gender(s): Both.


Inclusion Criteria:

- Male or female out-patient aged from 18 years to 65 years

- Clinical diagnosis of moderate persistent asthma for at least 6 months, according to

GINA revised version 2006 guidelines

- Post-bronchodilator forced expiratory volume (FEV1) at least 80% of the predicted

- Either positive methacholine challenge test (PC20 FEV1< 4mg/ml or PD20 FEV1<0. 8 mg)

or positive response to the reversibility test in the last year

- Asthma either not adequately controlled with low-dose (≤500 mcg beclomethasone or

equivalent) inhaled corticosteroids (ICS) or controlled by bid inhaled combination of low-dose ICS/long acting beta-2 agonists (LABA)

- A co-operative attitude and ability to be trained to correctly use the dry powder

inhalator and to complete the diary cards

- Written informed consent obtained

Exclusion Criteria:

- Inability to carry out pulmonary function testing

- Moderate severe asthma associated with reduced lung function

- History of near-fatal asthma and/or admission intensive care unit because of asthma

- 3 or more courses of oral corticosteroids or hospitalization for asthma during the

previous year

- Diagnosis of COPD as defined by the GOLD guidelines

- Evidence of severe asthma exacerbation or symptomatic infection of the airways in the

previous 8 weeks

- Current smokers or recent (less than one year) ex-smokers, defined as smoking at

least 10 pack/years

- History or current evidence of heart failure, coronary artery disease, myocardial

infarction, severe hypertension, or cardiac arrhythmias

- Diabetes mellitis

- Percutaneous transluminal coronary angioplasty (PTCA) or coronary artery by-pass

graft (CABG) during the previous six months

- Abnormal ECG

- Clinically significant or unstable concurrent diseases: uncontrolled hyperthyroidism,

significant hepatic impairment, poorly controlled pulmonary disease (tuberculosis, active mycotic infection of the lung), gastrointestinal (e. g., active peptic ulcer), neurological or haematological autoimmune diseases

- Malignancy

- Any chronic diseases with prognosis < 2 years

- Pregnant or lactating females or not able to exclude pregnancy during the study


- History of alcohol or drug abuse

- Patients treated with monoamine oxidase inhibitors, tricyclic antidepressants or

beta-blockers as regular use

- Allergy, sensitivity or intolerance to study drugs and/or study drug formulation


- Patients unlikely to comply with the protocol or unable to understand the nature,

scope and possible consequences of the study

- Patients who received any investigational new drug within the last 12 weeks

- Patients who have been previously enrolled in this study

Locations and Contacts

Servizio Pneumologico ASL Brindisi, Brindisi, Italy

Seconda UniversitĂ  degli stuidi di Napoli, unitĂ  Operativa di Pneumologia, Napoli, Italy

Giuseppina Bertorelli, Parma 43100, Italy

UniversitĂ  di Roma Tor Vergata, unitĂ  di malattie dell'apparato Respiratorio, Roma, Italy

Ospedale regionale Umberto I, UnitĂ  Operativa di Allergologia, Ancona, AN, Italy

Fondazione S. Maugeri - IRCCS -dipartimento di Pneumologia riabilitativa, Cassano delle Murge, BA, Italy

Dipartimento di Scienze Mediche-UnitĂ  Operativa di Pneumologia, Benevento, BN 82100, Italy

Policlinico Sant'Orsola Malpighi, UnitĂ  Operativa di Pneumologia, Bologna, BO, Italy

UniversitĂ  degli Studi di Catania, UnitĂ  operativa di Pneumologia, Catania, CT, Italy

UniversitĂ  Magna Grecia Catanzaro, unitĂ  operativa di Pneumologia, Catanzaro, CZ, Italy

Ospedale Morgagni Pierantoni, azienda Ospedaliera di Forlì, Unitaà operativa di Pneumologia, Forlì, FC, Italy


UniversitĂ  degli studi di Foggia, ospedale pneumologico D'Avanzo, unitĂ  operativa di malattie dell'apparato respiratorio, Foggia, FG, Italy

Ospadale San Carlo Borromeo - UnitĂ  operativa di Pneumologia, Milano, MI, Italy

Ospedale cittĂ  di Sesto San Giovanni, UnitĂ  operativa di Pneumologia, Sesto San Giovanni, MI, Italy

UniversitĂ  di Modena e Reggio Emilia, UnitĂ  operativa di Pneumologia, Modena, MO, Italy

UniversitĂ  degli studi di Padova, dipartimento di Pneunmologia, Padova, PD, Italy

UniversitĂ  degli studi di Padova, Medicina del Lavoro, Padova, PD, Italy

UniversitĂ  degli studi di Pisa, Ospedale Cisanello, unitĂ  operativa di Pneumologia, Pisa, PI, Italy

UniversitĂ  degli stiudi di Parma, unitĂ  operativa di Pneumologia, Parma, PR, Italy

IRCCS Fondazione S Maugeri, Dipartimento di Allergologia, Pavia, PV, Italy

UniversitĂ  degli studi di Pavia, dipartimento di Pneumologia, Pavia, PV, Italy

UniversitĂ  degli Studi di Palermo, Ospedale "V. Cervello", Palermo, Pa 90146, Italy

universitĂ  Cattolica del Sacro Cuore, Columbus, unitĂ  operativa di allergologia, Roma, RM, Italy

UniversitĂ  Cattolica del Sacro Cuore, Policlinico Gemelli, unitĂ  operativa di Pneumologia, Roma, RM, Italy

UniversitĂ  Roma La Sapienza, servizio di Fisiopatologia respiratoria, Roma, RM, Italy

UniversitĂ  di Perugia -Terni, Medcina del lavoro Terni, Terni, TI, Italy

UniversitĂ  degli studi di Torino, Dipartimento di scienze biomediche ed oncologia umana, Torino, TO, Italy

Ospedale di Cattinara, unitĂ  operativa di pneumologia, Trieste, TS, Italy

Ospedale di Bussolengo, UnitĂ  operativa di Pneumologia, Bussolengo, VR, Italy

azienda universitaria-ospedaliera istituti ospitalieri di Verona, unitĂ  operativa di Allergologia, Verona, VR, Italy

Additional Information

Starting date: April 2009
Last updated: May 29, 2014

Page last updated: August 23, 2015

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