Fluticasone versus salmeterol/low-dose fluticasone for long-term asthma control.
OBJECTIVE
To evaluate the relative clinical superiority of increasing the dose of fluticasone propionate versus the addition of salmeterol to low-dose fluticasone propionate for long-term asthma control.


METHODS
Literature was identified by a MEDLINE search (1966-October 2002). Key search terms included asthma, inhalation, corticosteroid, beta-adrenergic agonist, and combination drug therapy.


RESULTS
Current guidelines for long-term control of asthma include treatment with either inhaled corticosteroids (medium dose) or inhaled corticosteroids (low to medium dose) in combination with a long-acting bronchodilator. Previous studies evaluating salmeterol or formoterol combination therapy with beclomethasone or budesonide have generally produced superior results compared with increasing the dose of the inhaled corticosteroid. Four recent controlled clinical trials have compared the clinical utility of fluticasone propionate monotherapy versus salmeterol/low-dose fluticasone propionate for long-term asthma control in patients with moderate to severe persistent asthma. Based on spirometry data, rescue albuterol use, and symptom scores, the addition of salmeterol to low-dose fluticasone propionate was superior to increasing the dose of fluticasone propionate.


CONCLUSIONS
Based on improvements in forced expiratory volume in 1 second, peak expiratory flow, and symptom control, the addition of salmeterol to low-dose fluticasone propionate provides better control of asthma than increasing the dose of fluticasone propionate.
Heyneman
Catherine A
CA
Idaho Drug Information Service, Pocatello, USA. cathy@otc.isu.edu
Crafts
Rachel
R
Holland
Jerry
J
Arnold
Aaron D
AD
D000420:Albuterol / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use*; D000730:Androstadienes / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000068298:Fluticasone; D006801:Humans; D000068299:Salmeterol Xinafoate
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol