title: Long-term comparison of 3 controller regimens for mild-moderate persistent childhood asthma: the Pediatric Asthma Controller Trial.
abstract: BACKGROUND
  More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children.
  
  
  OBJECTIVE
  The Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in achieving asthma control.
  
  
  METHODS
  A total of 285 children (ages 6-14 years) with mild-moderate persistent asthma on the basis of symptoms, and with FEV(1) >or= 80% predicted and methacholine FEV(1) PC(20) <or= 12.5 mg/mL, were randomized to 1 of 3 double-blind 48-week treatments: fluticasone 100 microg twice daily (fluticasone monotherapy), fluticasone 100 microg/salmeterol 50 microg in the morning and salmeterol 50 mug in the evening (PACT combination), and montelukast 5 mg in the evening. Outcomes included asthma control days (primary outcome), exacerbations, humanistic measurements, and pulmonary function measurements.
  
  
  RESULTS
  Fluticasone monotherapy and PACT combination were comparable in many patient-measured outcomes, including percent of asthma control days, but fluticasone monotherapy was superior for clinic-measured FEV(1)/forced vital capacity (P = .015), maximum bronchodilator response (P = .009), exhaled nitric oxide (P < .001), and PC(20) (P < .001). Fluticasone monotherapy was superior to montelukast for asthma control days (64.2% vs 52.5%; P = .004) and for all other control outcomes. Growth over 48 weeks was not statistically different (fluticasone, 5.3 cm; PACT combination, 5.3 cm; montelukast, 5.7 cm).
  
  
  CONCLUSIONS
  Both fluticasone monotherapy and PACT combination achieved greater improvements in asthma control days than montelukast. However, fluticasone monotherapy was superior to PACT combination in achieving other dimensions of asthma control. Growth was similar in all groups.
  
  
  CONCLUSIONS
  Therefore, of the regimens tested, the PACT study findings favor fluticasone monotherapy in treating children with mild-moderate persistent asthma with FEV(1) >or= 80% predicted, confirming current guideline recommendations.
authors.affiliation: Clinical Science Center, University of Wisconsin, Madison, WI 53792, USA. Sorkness@facstaff.wisc.edu
authors.forename: Christine A
authors.initials: CA
authors.lastname: Sorkness
authors.forename: Robert F
authors.initials: RF
authors.lastname: Lemanske
authors.forename: David T
authors.initials: DT
authors.lastname: Mauger
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Boehmer
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.forename: Fernando D
authors.initials: FD
authors.lastname: Martinez
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Bacharier
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bloomberg
authors.forename: Ronina A
authors.initials: RA
authors.lastname: Covar
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.forename: Gregory
authors.initials: G
authors.lastname: Heldt
authors.forename: Gary
authors.initials: G
authors.lastname: Larsen
authors.forename: Michael H
authors.initials: MH
authors.lastname: Mellon
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Morgan
authors.forename: Mark H
authors.initials: MH
authors.lastname: Moss
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Spahn
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Taussig
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000293:Adolescent; D000420:Albuterol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000730:Androstadienes / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001827:Body Height / Q000187:drug effects; D002648:Child; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D000068298:Fluticasone; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D011804:Quinolines / Q000627:therapeutic use*; D000068299:Salmeterol Xinafoate; D013440:Sulfides
chemical_list: D000085:Acetates; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D011804:Quinolines; D013440:Sulfides; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; C093875:montelukast; D000420:Albuterol