SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

9/19/05

Moderate dose inhaled corticosteroids plus salmeterol vs high dose inhaled corticosteroids in asthma

Summary
Background - Previous studies have shown that addition of inhaled salmeterol (Sal) to inhaled corticosteroids (ICS) allows asthma control at least as good as seen with treatment with twice the dose of ICS. But at what ICS dose should Sal be added?

Findings - Masoli et al of the Medical Research Institute of Wellington, NZ carried out a meta-analysis of double blind studies comparing the efficacy of 1) adding Sal to fluticasone propionate (FP), 200mcg/day vs 2) increasing the FP dose at least two fold in symptomatic adult patients with asthma.

Based on findings in a total 4,576 asthmatics in 12 studies, they found that the frequency of subjects withdrawn from the studies because of worsening asthma and acute asthma exacerbation was more common in those on the higher doses of FP than in those on FP plus Sal (Odds Ratio = 1.58, 1.35, respectively). The FEV-1, peak expiratory flow, and daytime beta agonist use were improved in the FP plus Sal group more than in higher dose FP group. The authors concluded that asthma, not adequately controlled on FP 200 mcg/day is benefited more by addition of Sal than by increasing the dose of FP at least two fold.

Reference
 Thorax 2005;60:730-4

Editor's Comments
The findings in this meta-analysis are in agreement with my impressions from reading individual studies in this area. Patients have also reported a better asthma related quality of life when long acting beta agonist such as Sal is added to ICS rather than when the ICS dose is increased two fold. However, to my knowledge, what is not known is whether such addition of Sal prevents the airway remodeling that may occur in chronic asthma.

 

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