SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

11/9/05

Control of asthma with combination of fluticasone and salmeterol

Summary
Background - Previous relatively short-term studies have shown that adding an inhaled long acting beta agonist (LABA) such as salmeterol (Sal) to low doses of an inhaled corticosteroid (ICS) such as fluticasone propionate (FP) provides enhanced asthma control. But how much more effective is such Sal/FP combination therapy than the individual components when used for one year?

Findings - Lundback et al of the Karolinska Institute in Sweden carried out a randomized, double blind, parallel-group comparison of Sal/FP (50 microg/250 mcg) vs Sal 50 microg alone vs FP 250 microg alone each given b.i.d. for 12 months in 282 adults with mild to moderate asthma.

Fewer patients required an increase in study medication in those treated with Sal/FP (11%) than those treated with FP alone (35%) or Sal alone (61%). Also significantly fewer patients had at least 2 acute asthma exacerbations during the 12 month study period in those treated with Sal/FP(4%) than in those treated with FP alone (17%) or Sal alone (40%).

Airway hyper-reactivity was also less in those treated with Sal/FP than those treated with Sal alone.

Reference
Respir Med 2005;Oct 20, E pub

Editor's Comments
These findings show convincingly that at least some aspects of asthma control over a 12 month period are superior with Sal/FP combination therapy. One would have liked to see reduced daily total asthma symptoms scores in those treated with Sal/FP but this effect is not mentioned in this report.

The mechanisms underlying the improved asthma control with Sal/FP is still not well defined. Although the authors of this report postulated greater anti-inflammatory effects a recent study found no greater reduction in sputum eosinophilia with a combination of LABA and ICS than with ICS alone.

 

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