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        "titulo" => "Discrepancias en la clasificaci&#243;n de los glucocorticoides inhalados entre GEMA y GINA"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the letter signed by Doctors Entrenas-Costa and Entrenas-Castillo<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in which they suggest that the classification of the dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g of fluticasone furoate &#40;FF&#41; once a day &#40;OD&#41; that appears in the GEMA guidelines as medium dose<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> should be &#8220;corrected&#8221; and classified in line with the GINA guidelines as low dose&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">GEMA is a clinical practice guideline drawn up by independent experts from 15 different scientific societies&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The classification of 100<span class="elsevierStyleHsp" style=""></span>&#956;g FF OD as a medium dose is evidence-based and consistent with the approved Summary of Product Characteristics &#40;SPC&#41; for FF<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and with the classifications of other relevant international guidelines&#44; such as SIGN 158 in the UK and the Australian Asthma Handbook&#46; Few direct comparisons are available with FF and other inhaled glucocorticoids&#44; particularly at low doses&#44; so it is difficult to establish the exact equipotent dose &#40;equivalent in efficacy and safety&#41; of FF&#46; According to the SPC&#44; a daily dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g of FF in asthma is approximately equivalent to 250<span class="elsevierStyleHsp" style=""></span>&#956;g of fluticasone propionate &#40;FP&#41; twice a day &#40;BID&#44; medium dose&#41;&#44; while 200<span class="elsevierStyleHsp" style=""></span>&#956;g FF OD is approximately equivalent to 500<span class="elsevierStyleHsp" style=""></span>&#956;g FP BID &#40;high dose&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> A low dose of FF is not approved in asthma&#46; Evidence of efficacy and safety with 50<span class="elsevierStyleHsp" style=""></span>&#956;g of FF OD in mild-moderate asthma is low and inconsistent&#44; although at least one of the published studies indicates greater efficacy than placebo and approximately similar efficacy to that of low-dose FP &#40;100<span class="elsevierStyleHsp" style=""></span>&#956;g BID&#41; in mild asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With regard to safety&#44; the authors comment that the dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g FF does not suppress cortisol&#44; based on a pharmacokinetic&#47;pharmacodynamic model and limited data from a 6-week study&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; in a 52-week study of 503 adults and adolescents with asthma specifically designed to assess safety&#44; 24-h urinary cortisol excretion at the medium dose of 100<span class="elsevierStyleHsp" style=""></span>&#956;g FF OD was similar to that obtained at the high dose of 500<span class="elsevierStyleHsp" style=""></span>&#956;g FP BID after 1 year of treatment&#44; and about 10&#37; of patients treated with 100<span class="elsevierStyleHsp" style=""></span>&#956;g FF had persistently low urinary cortisol levels &#40;&#60;40<span class="elsevierStyleHsp" style=""></span>nmol&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41; during treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> All inhaled glucocorticoids present a risk of systemic &#40;e&#46;g&#46; pneumonia&#44; cortico-adrenal axis suppression&#44; osteoporosis&#44; glaucoma&#44; etc&#46;&#41; and local &#40;candidiasis&#44; etc&#46;&#41; adverse effects&#44; all of which are dose-dependent&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As a result&#44; until new data become available&#44; we believe that the classification of 100<span class="elsevierStyleHsp" style=""></span>&#956;g FF as a medium dose is the most correct and prudent option&#46; Treatment for asthma maintenance should be administered at the minimum dose required to maintain disease control<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in order to minimize the risk of adverse effects&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Plaza Moral V&#44; G&#243;mez-Outes A&#44; Quirce Gancedo S&#44; Alobid I&#44; &#193;lvarez Rodr&#237;guez C&#44; Blanco Aparicio M&#44; et al&#46; Discrepancias en la clasificaci&#243;n de los glucocorticoides inhalados entre GEMA y GINA&#46; Arch Bronconeumol&#46; 2020&#59;56&#58;472&#8211;473&#46;</p>"
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