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SELECTED ARTICLES FROM THE RECENT LITERATURE 2007
September 20, 2007
Beclomethasone/formoterol vs fluticasone/salmeterol in moderate to severe asthma
Summary
Background - A combination of an inhaled corticosteroid (ICS) and inhaled long acting beta agonist (LABA) is recommended for treatment of moderate to severe persistent asthma (PA). The combination of fluticasone (Flut - an ICS) and salmeterol (Sal - a LABA) marketed as Advair is used commonly in the USA to treat of moderate to severe PA. But are other ICS/LABA combinations as effective in such situations?
Findings - Papai et al of the Univ of Ferrara in Italy carried out a multicenter, randomized, double blind comparison of beclomethasone 200 mcg/formoterol 12 mcg (Becl/Form) b.i.d. vs fluticasone 250 mcg/salmeterol 50 mcg (Flut/Sal) b.i.d in 226 patients with moderate to severe asthma.
After 12 weeks of such treatment, there was significant in asthma symptom score, lung function tests and use of asthma rescue medication in both treatment groups with no significant difference in morning peak flow levels between the groups. There was also no difference in the frequency of acute asthma exacerbations or adverse events in the 2 treatment groups. The overnight urinary cortisol/creatinine ratios were also not significantly different.
Reference
Allergy 2007;62:1182-88
Editor's Comments
The somewhat surprising finding in this study was that the clinical efficacy of similar doses of Becl and Flut was not significantly different considering the greater affinity of Flut for corticosteroid tissue receptors. This lack of significant difference between Flut and Becl effects may be related to the use of an extra fine Becl particle size in their prep which penetrates very deeply into the peripheral airways. The reasons for similar cortisol/creatinine urinary ratios during the Becl and Flu treatment requires further investigation. Recall that some of the Becl is swallowed and then absorbed systemically.
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