SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
10/22/04
Review of fluticasone dose response in asthmatic children
Summary
Background - Fluticasone (Flut) is one of the most commonly prescribed inhaled corticosteroids (ICS) in asthma treatment. Flut is considered quite potent. However, questions have been raised about the efficacy and safety of increasing doses of Flut used chronically.
Findings - Masoli et al of the Medical Research Institute of New Zealand carried out a systematic review of double-blind, randomized, dose-response studies of Flut treatment for least 4 weeks duration in childhood asthma. They found that the Flut dose response for clinical efficacy begins to plateau at doses between 100-200 mcg/day. There was additional clinical efficacy at a daily dose of 400 mcg in children with severe asthma. However, there was evidence of suppression of the HPA axis at 400 mcg/day.
Reference
Arch Dis Child 2004;89: 902-7
Editor's Comments
Flut has been advertised as a particularly potent ICS because of its greater affinity for corticosteroid receptors in the airways when compared to other ICS agents. However, a number of clinicians have raised concerns that when Flut is absorbed from the lungs after inhalation treatment, Flut would then bind avidly to corticosteroid receptors on other (systemic) tissues. The result of such binding could be greater potential for adverse systemic effects such as HPA axis suppression. The review described above supports the impression that Flut effects in most asthmatics plateau at a daily dose less (probably 50%) of that seen when other ICS agents are used. However, systemic adverse effects of Flut occur at daily doses of 400 mcg. a dose which does generally not cause adverse systemic effects when ICS such as budesonide are used. Similar conclusions about the dose-dependent efficacy and potential adverse effects of Flut were also reached in another recent report (Eur Respir J 2004;24:420-5).
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