SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

12/29/06

Reduction of fluticasone dosage by added salmeterol and tioproprium in persistent asthma

Summary
Background - The addition of inhaled salmeterol (Sal), a long acting beta agonist, frequently permits significant reductions in the dosage of inhaled corticosteroids (ICS) such as fluticasone (Flut) required to control persistent asthma (PA). Tioproprium (Tio) is an inhaled anti-cholinergic drug which may be a significant bronchodilator in PA.

Findings - Fardon et al of the Univ of Dundee carried out a double blind, crossover study comparing the effects of adding: 1) Sal 100 mcg BD plus placebo to Flut 500 mcg BD plus Tio 18 mcg/day vs 2) salmeterol 100 mcg BD plus placebo to Flut 500 mcg BD in 18 adults with severe PA just previously treated with Flut 1000 mcg/day.

After 4 weeks of such treatments, they found that: 1) Sal plus the 50% reduced dose of Flut was followed by a modest (mean = 41.5L) increase in morning Peak Expiratory Flow (PEF) when compared to that seen during treatment with Flut 1000 mcg/day as monotherapy; 2) when Sal and Tio were used with the reduced Flut dose, similar increases in the FEV-1 (17o ml) and FVC (240 ml). The expired NO levels also decreased (p<0.05).

However, there were no significant changes in asthma symptoms or asthma related quality of life assessment.

Reference
Respir Med 2006; Dec 16, E pub

Editor's Comments
Inhaled anti-cholinergics are as effective as inhaled albuterol in relieving acute asthma exacerbations in some studies. The clinical significance of the modestly greater improvement in expiratory airflow seen in this study are not yet clear. However, further investigation is warranted, especially in the face of concerns raised about chronic use of inhaled salmeterol.

 

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