A comparison of the efficacy of once-daily fluticasone furoate/vilanterole with twice-daily fluticasone propionate/salmeterol in asthma-COPD overlap syndrome.
BACKGROUND
Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is important because patients with ACOS have significantly worse outcomes compared with those with asthma or chronic obstructive pulmonary disease (COPD) alone. Inhaled corticosteroids (ICS), together with a long-acting β2 agonist (LABA), are recommended, but no therapeutic studies for ACOS have been conducted. Recently, fluticasone furoate/vilanterole (FF/VI) has been approved as the first once-daily ICS/LABA combination therapy for asthma and COPD.


METHODS
A 12-week, randomized, open-label cross-over study was conducted in 16 patients with ACOS to compare the effectiveness of once-daily FF/VI 200/25 μg vs. twice-daily fluticasone propionate/salmeterol (FP/SAL) 500/50 μg. The study period included a 4-week run-in, the first 4-week treatment, and the second 4-week treatment. Respiratory functions, including forced expiratory volume in 1 s (FEV1) and respiratory impedance using the forced oscillation technique (FOT), were measured, as was fractional exhaled nitric oxide (FeNO). A COPD assessment test (CAT) scores and asthma control test (ACT) scores were recorded 0, 4, and 8 weeks after randomization.


RESULTS
The mean values for the FEV1 were 1.33 (±0.29) L in the run-in period, 1.38 (±0.39) L after the FP/SAL treatment period, and 1.47 (±0.38) L after the FF/VI treatment period. The FEV1 value after the FF/VI treatment was significantly greater than the value after the run-in period (p < 0.01). FOT parameters, FeNO levels, CAT scores, ACT scores, and other blood tests were not significantly different during the run-in period, the FP/SAL treatment period, and the FF/VI treatment period.


CONCLUSIONS
FF/VI, the first once-daily ICS/LABA, can provide substantial improvement in lung functions, indicating that FF/VI should be considered for the regular treatment of ACOS.
Respiratory Medicine, Toyama City Hospital, Toyama, Japan. Electronic address: ishiura-@p2322.nsk.ne.jp.
Yoshihisa
Y
Ishiura
Respiratory Medicine, National Hospital Organization Nanao Hospital, Nanao, Japan.
Masaki
M
Fujimura
Respiratory Medicine, Toyama City Hospital, Toyama, Japan.
Yasutaka
Y
Shiba
Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Noriyuki
N
Ohkura
Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Johsuke
J
Hara
Respiratory Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Kazuo
K
Kasahara
D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy*; D001592:Benzyl Alcohols / Q000008:administration & dosage / Q000627:therapeutic use*; D002722:Chlorobenzenes / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination / Q000627:therapeutic use*; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D012129:Respiratory Function Tests
D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D001592:Benzyl Alcohols; D002722:Chlorobenzenes; D004338:Drug Combinations; D000068297:Fluticasone-Salmeterol Drug Combination; C550468:vilanterol; D009569:Nitric Oxide; C523187:fluticasone furoate
ACOS; Asthma; COPD; FF/VI