Combination Therapy Salmeterol/Fluticasone Versus Doubling Dose of Fluticasone in Children With Asthma

Abstract

In our study the efficacy on symptom control and lung function of the combination of a long-acting bronchodilator with inhaled corticosteroid is equal to doubling the dose of the inhaled corticosteroid in children still symptomatic on a moderate dose of inhaled corticosteroid.

Inhaled Corticosteroids in Lung Diseases

“…Biomarkers of inflammation, such as fraction of exhaled nitric oxide (FeNO), sputum eosinophils, serum eosinophil cationic protein, and exhaled breath condensates, have been advocated as outcome measures; however, each has drawbacks, including not predicting overall asthma control or not predicting the risk of exacerbations (57,58). Increasingly, asthma control days or episode-free days that are defined as a day without symptoms or rescue bronchodilator use have been used as an outcome measure for comparative studies (50,59). The measurement of asthma control days may be more sensitive than lung function changes to dosing changes with ICSs and may be more clinically relevant (15,57,59).…”

“…Increasingly, asthma control days or episode-free days that are defined as a day without symptoms or rescue bronchodilator use have been used as an outcome measure for comparative studies (50,59). The measurement of asthma control days may be more sensitive than lung function changes to dosing changes with ICSs and may be more clinically relevant (15,57,59).…”

A 12-week open-label, randomized, controlled trial and 24-week extension to assess the efficacy and safety of fluticasone propionate/formoterol in children with asthma

“…The GINA guideline recommends increasing ICS dose as a preferred step-up therapy for children uncontrolled on low-dose ICS or switching to a low-dose combination treatment with an ICS and a long-acting β 2 -agonist (LABA) as another option. Both strategies have been shown to be equally effective [Vaessen-Verberne et al 2010], although a study by Lemanske Jr. and colleagues showed that addition of LABA to low-dose ICS was more likely to result in best response than increasing the dose of ICS [Lemanske Jr. et al 2010]. Concerns have also been raised regarding doubling the dose of ICS monotherapy in children due to possible effects on adrenal function and short-term growth suppression [Allen, 2006;Pedersen, 2001;Robinson et al 2002].…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…In children, the preferred option is to increase ICS to medium dose (see Box 3-6, p.44), 172 and in this age group, the effect may be similar to 173 or more effective 174,175 than adding LABA.…”