title: Comparison of the clinical effects of combined salmeterol/fluticasone delivered by dry powder or pressurized metered dose inhaler.
abstract: The salmeterol/fluticasone combination (SFC) inhaler is currently the most widely used maintenance drug for asthmatics worldwide. Although the effectiveness of SFC as either a dry powder inhaler (DPI) or a pressurized metered dose inhaler (pMDI) is well documented, there is limited data comparing the clinical efficacies of the two devices. To address this issue, we carried out a randomized crossover trial in which asthmatic patients (n = 47; mean age, 62.5 ± 16.5 years old) received a 12-week treatment of SFC DPI (50/250 μg twice daily) or SFC pMDI (four puffs of 25/125 μg daily). After a 4-week washout period, patients received another crossover treatment for 12 weeks. Respiratory resistance and reactance were measured by forced oscillation technique (MostGraph-01), spirometry, fractional exhaled nitric oxide (FeNO), and an asthma control test (ACT) every 4 weeks. The mean forced expiratory volume1.0 at the baseline was 2.16 ± 0.86 (L). Respiratory system resistance at 5 Hz (R5), the difference between R5 and R at 20 Hz (R5 - R20), and FeNO improved in both treatment groups, while reactance at 5 Hz (X5) and ACT score improved only in the pMDI group. In patients >70 years old (n = 21), R5, R5 - R20, ΔX5, and FeNO improved only in the pMDI group. These results suggest that SFC by pMDI produces a stronger anti-inflammatory and bronchodilatory effect even in patients whose asthma is well controlled by SFC delivered by DPI.
authors.affiliation: Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan. Electronic address: houjiyou-ncgm@umin.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hojo
authors.affiliation: Department of Respiratory Medicine, Shizuoka General Hospital, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Shirai
authors.affiliation: Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Hirashima
authors.affiliation: Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan.
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Iikura
authors.affiliation: Division of Respiratory Medicine, National Center for Global Health and Medicine, Japan.
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018592:Cross-Over Studies; D058995:Dry Powder Inhalers; D005260:Female; D000068297:Fluticasone-Salmeterol Drug Combination / Q000008:administration & dosage* / Q000627:therapeutic use; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D011446:Prospective Studies; D013147:Spirometry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D000068297:Fluticasone-Salmeterol Drug Combination
keywords: Bronchial asthma; Dry powder inhaler; Forced oscillation technique; Pressurized metered dose inhaler; Salmeterol/fluticasone combination inhaler