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Am Fam Physician. 2006;74(7):1203

Asthma management should provide relief therapy that rapidly improves lung function, prolongs action, and can be repeated without side effects. The therapy also should protect patients against triggers (e.g., exercise). Formoterol (Foradil) is an inhaled, fullbeta2 agonist similar to other asthma therapies. One dose of formoterol provides relief and protection for eight to 12 hours compared with a short-acting beta2 agonist that only lasts two to four hours. Adults can increase the dose of formoterol during asthma exacerbations without decreasing its safety profile. Hermansen and colleagues assessed the effect of formoterol versus terbutaline (Brethine) during exercise-induced bronchoconstriction in children with asthma.

Children who were seven to 15 years of age with persistent asthma and had a decrease of forced expiratory volume in one second (FEV1) by at least 15 percent after exercise were included in the study. Participants were randomized to receive formoterol (9 mcg), terbutaline (0.5 mg), or placebo. The study was a randomized, double-blind, placebo-controlled, crossover trial.

Spirometry was performed before exercise as well as one, three, and five minutes after the session. Additionally, it was repeated one, three, five, 10, 15, 20, 30, and 60 minutes after the study drug was administered. A standardized treadmill test that used American Thoracic Society guidelines to reach submaximal workload was used during the exercise session, and a face mask ensured that nasal breathing was prevented.

Twenty-six children were enrolled in the study. The authors noted that formoterol and terbutaline provided a significant bronchodilatory effect at three minutes compared with placebo. At five minutes, both medications had similar effects on FEV1, and the mean increase from each predrug baseline was 62 percent of the maximum increase for each drug. The median recovery times were 5.0 minutes for formoterol and 7.4 minutes for terbutaline (P = .33). Twenty-three of the 24 patients who were treated with formoterol reached their recovery limit at 60 minutes compared with 24 of the 24 patients who were treated with terbutaline.

The authors conclude that formoterol provided similar bronchodilatory effects compared with terbutaline during exercise-induced asthma in children who were diagnosed with persistent asthma. They add that formoterol appears to be as effective as terbutaline and should be considered as an alternative treatment for acute bronchoconstriction in children.

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