Using the Fluticasone Propionate and Salmeterol Combination to Achieve Guideline-Defined Asthma Control in a Wide Range of Patients

Abstract

Despite the availability of effective medication, studies suggest that asthma control is inadequate in at least 55% of affected individuals. However, the recently revised Global Strategy for Asthma Management and Prevention guidelines, developed by the Global Initiative for Asthma (GINA), suggest that effective asthma control is possible in most patients, through appropriate pharmacological management involving both the physician and patient. The 2007 GINA guidelines recommend a stepwise approach to asthma management, whereby treatment is "stepped up" until control is achieved. The guidelines also recommend using an inhaled corticosteroid (ICS) combined with a long-acting ␤ 2 -agonist (LABA) in patients whose asthma is uncontrolled on current ICS treatment and in treatmentnaive patients who are very symptomatic. A wide range of patients, are therefore, appropriate candidates for combined LABA/ICS treatment. Combination therapy with salmeterol/fluticasone propionate combination (SFC) has been shown to achieve guideline-defined control more closely than fluticasone propionate (FP) alone, an increased dose of FP, or a combination of FP plus leukotriene receptor antagonist. Regular and sustained treatment with SFC controls inflammation, prevents symptoms, and significantly improves lung function compared with FP alone or FP plus leukotriene receptor antagonist. In addition, aiming for guideline-defined control of asthma symptoms can help to prevent exacerbations. This review discusses how SFC can be used to achieve guideline-defined asthma control in a wide range of patients and presents the clinical evidence to support this. Strategies are discussed for stepping down SFC once control is achieved, which is a further key recommendation from the GINA guidelines.