Fluticasone propionate powder: Oral corticosteroid–sparing effect and improved lung function and quality of life in patients with severe chronic asthma☆,☆☆,★
Section snippets
Patients
Male and female patients 12 years of age or older with chronic asthma diagnosed according to the American Thoracic Society criteria,19 who required regular maintenance treatment with oral corticosteroids over the preceding 6 months, were enrolled provided they had been receiving a stable minimum effective dose of oral prednisone of 5 to 40 mg daily or 10 to 80 mg every other day for at least 2 weeks immediately before the study. Prior use of β2 -agonists was required, whereas prior use of
RESULTS
Demography and pulmonary function of the 111 patients (ages 12 to 77 years) randomized to study treatment were comparable across treatment groups (Table I).Empty Cell Placebo FP 500 μg BID FP 1000 μg BID No of patients enrolled 34 41 36 Sex, M/F (%) 38/62 39/61 42/58 Age, mean (range) (y) 49 (16-74) 49 (12-77) 50 (15-76) No of patients receiving daily prednisone 27 34 26 No of patients receiving alternate-day prednisone 7 7 10 Mean prednisone dose (mg)
DISCUSSION
Despite treatment with inhaled corticosteroids, salmeterol, and theophylline, a proportion of patients with asthma require chronic oral corticosteroids to control their disease. In this trial, patients treated twice daily with fluticasone propionate powder 500 or 1000 μg were able to reduce or eliminate oral prednisone use, as well as discontinue other inhaled corticosteroids, while significantly improving their pulmonary function, asthma control, and quality of life. These results suggest that
Acknowledgements
We thank the following for their contributions to this study: P. Chervinsky, MD, North Dartmouth, Mass; P. E. Korenblat, MD, St Louis, Mo; C. LaForce, MD, Raleigh, NC; D. Q. Mitchell, MD, Jackson, Miss; J. Pinnas, MD, Tucson, Ariz; M. Strek, MD, Chicago, Ill; and S. F. Weinstein, MD, Huntington Beach, Calif. We would also like to thank Shehnaz Gangjee for assistance in writing this manuscript.
References (37)
- et al.
Complications of long-term steroid therapy for asthma
J Allergy Clin Immunol
(1972) - et al.
Methotrexate in the treatment of steroid-dependent asthma
J Allergy Clin Immunol
(1991) - et al.
Trial of cyclosporin in corticosteroid-dependent chronic severe asthma
Lancet
(1992) The human pharmacology of fluticasone propionate
Respir Med
(1990)- et al.
Binding kinetics of fluticasone propionate to the human glucocorticoid receptor
Steroids
(1994) - et al.
Fluticasone propionate powder administered through Diskhaler versus triamcinolone acetonide aerosol administered through metered-dose inhaler in patients with persistent asthma
J Allergy Clin Immunol
(1997) - et al.
Clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half the microgram dose or less
Respir Med
(1998) - et al.
Fluticasone propionate improves quality of life in patients with asthma requiring oral corticosteroids
Ann Allergy Asthma Immunol
(1996) - et al.
Determining a minimal important change in a disease-specific quality of life instrument
J Clin Epidemiol
(1994) - et al.
Fluticasone propionate aerosol for the treatment of adults with mild to moderate asthma
J Allergy Clin Immunol
(1994)
Mucosal inflammation in asthma
Am Rev Respir Dis
Guidelines for the diagnosis and management of asthma
Corticosteroids: a review with emphasis on complications of prolonged systemic therapy
Ann Allergy
Pathogenesis and treatment of steroid osteoporosis
Clin Endocrinol
Auranofin in the treatment of steroid dependent asthma: a double-blind study
Thorax
Structure-activity relationships of topically active steroids: the selection of fluticasone propionate
Respir Med
Distribution of inhaled fluticasone propionate between human lung tissue and serum in vivo
Eur Respir J
Differential effects of inhaled corticosteroids: fluticasone propionate versus triamcinolone acetonide
Am J Managed Care
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Supported by a grant from Glaxo Wellcome Inc, Research Triangle Park, NC.
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