{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:24:37Z","timestamp":1792027477654,"version":"4.4.0"},"reference-count":32,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100006259","name":"Teva Pharmaceutical Industries","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100006259","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002999","name":"Ministerie van Volksgezondheid, Welzijn en Sport","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100002999","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University Medical Centre Groningen","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2022,12,19]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Maintenance and reliever therapy (MART) with inhaled corticosteroid (ICS)\/formoterol effectively reduces exacerbations in asthma. We aimed to investigate its efficacy compared with fixed-dose fluticasone\/salmeterol in chronic obstructive pulmonary disease (COPD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with COPD and \u22651 exacerbation in the previous 2 years were randomly assigned to open-label MART (Spiromax budesonide\/formoterol 160\/4.5\u2009\u00b5g 2 inhalations twice daily+1\u2009prn) or fixed-dose therapy (Diskus fluticasone propionate\/salmeterol combination (FSC) 500\/50\u2009\u00b5g 1 inhalation twice daily+salbutamol 100\u2009\u00b5g prn) for 1\u2009year. The primary outcome was rate of moderate\/severe exacerbations, defined by treatment with oral prednisolone and\/or antibiotics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 195 patients were randomised (MART Bud\/Form n=103; fixed-dose FSC n=92). No significant difference was seen between MART and FSC therapy in exacerbation rates (1.32 vs 1.32\u2009\/year, respectively, rate ratio 1.05 (95% CI 0.79 to 1.39); p=0.741). No differences in lung function parameters or health status were observed. Total ICS dose was significantly lower with MART than FSC therapy (budesonide-equivalent 928\u2009\u00b5g\/day vs 1747\u2009\u00b5g\/day, respectively, p&lt;0.05). Similar proportions of patients reported adverse events (MART Bud\/Form: 73% vs fixed-dose FSC: 68%, p=0.408) and pneumonias (MART: 5% vs FSC: 1%, p=0.216).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This first study of MART in COPD found that budesonide\/formoterol MART might be similarly effective to fluticasone\/salmeterol fixed-dose therapy in moderate to severe patients with COPD, at a lower daily ICS dosage. Further evidence is needed about long-term safety.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/thorax-2022-219620","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T13:25:22Z","timestamp":1675257922000},"page":"451-458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Budesonide\/formoterol maintenance and reliever therapy versus fluticasone\/salmeterol fixed-dose treatment in patients with COPD"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1927-7646","authenticated-orcid":false,"given":"Susan","family":"Muiser","sequence":"first","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Imkamp","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianne","family":"Seigers","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nynke J","family":"Halbersma","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7531-4547","authenticated-orcid":false,"given":"Judith M","family":"Vonk","sequence":"additional","affiliation":[{"name":"Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart H D","family":"Luijk","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert-Jan","family":"Braunstahl","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Willem","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Isala Hospital, Zwolle, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart-Jan","family":"Kroesen","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Immunology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janwillem W H","family":"Kocks","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands"},{"name":"General Practitioners Research Institute, Groningen, The 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