Effect of different asthma treatments on risk of cold-related exacerbations

H. K. Reddel, C. Jenkins, S. Quirce, M. R. Sears, E. D. Bateman, P. M. O'Byrne, M. Humbert, R. Buhl, T. Harrison, G. G. Brusselle, A. Thorén, U. Sjöbring, S. Peterson, O. Östlund, G. S. Eriksson

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33 Citations (Scopus)


Common colds often trigger asthma exacerbations. The present study compared cold-related severe exacerbations during budesonide/formoterol maintenance and reliever therapy, and different regimens of maintenance inhaled corticosteroids (ICS), with or without long-acting β2-agonists (LABA), and with as-needed short-acting β2-agonists (SABA) or LABA.

Reported colds and severe exacerbations (defined by oral corticosteroid use and/or hospitalisation/emergency room visit) were assessed for 12,507 patients during 6–12 months of double-blind treatment. Exacerbations occurring ≤14 days after onset of reported colds were analysed by a Poisson model.

The incidence of colds was similar across treatments. Asthma symptoms and reliever use increased during colds. Budesonide/formoterol maintenance and reliever therapy reduced severe cold-related exacerbations by 36% versus pooled comparators plus SABA (rate ratio (RR) 0.64; p=0.002), and for individual treatment comparisons, by 52% versus the same maintenance dose of ICS/LABA (RR 0.48; p<0.001); there were nonsignificant reductions versus higher maintenance doses of ICS or ICS/LABA (RR 0.83 and 0.72, respectively). As-needed LABA did not reduce cold-related exacerbations versus as-needed SABA (RR 0.96).

Severe cold-related exacerbations were reduced by budesonide/formoterol maintenance and reliever therapy compared with ICS with or without LABA and with as-needed SABA. Subanalyses suggested the importance of the ICS component in reducing cold-related exacerbations. Future studies should document the cause of exacerbations, in order to allow identification of different treatment effects.
Original languageEnglish
Pages (from-to)584-593
Number of pages10
JournalEuropean Respiratory Journal
Issue number3
Publication statusPublished - 2011
Externally publishedYes

Bibliographical note

A correction exists for this article and can be found in European Respiratory Journal (2012) Vol. 39(5) p. 1280 at doi: 10.1183/09031936.50186510


  • asthma
  • drug therapy
  • exacerbations
  • respiratory tract infections


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