| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
ASTHMA |
1 Medical Research Institute of New Zealand, Wellington, New Zealand
2 Wellington School of Medicine & Health Sciences, Wellington, New Zealand
3 P3 Research, Wellington, New Zealand
4 University of Southampton, Southampton, UK
Correspondence to:
Correspondence to:
Professor R Beasley
Medical Research Institute of New Zealand, P O Box 10055, Wellington, New Zealand; richard.beasley{at}mrinz.ac.nz
Background: There is uncertainty as to the dose of inhaled corticosteroids (ICS) at which to start concomitant long acting ß agonist (LABA) treatment in patients with asthma not adequately controlled by ICS alone.
Methods: A meta-analysis was carried out of randomised, double blind clinical trials that compared the efficacy of adding salmeterol to moderate doses of ICS (fluticasone propionate 200 µg/day or equivalent) with increasing the ICS dose by at least twofold in symptomatic adult patients with asthma. The main outcome measures were the number of subjects withdrawn from the study due to asthma and the number of subjects with at least one moderate or severe exacerbation.
Results: Twelve studies with a total of 4576 subjects met the inclusion criteria for the analyses. The number of subjects withdrawn due to asthma and with at least one moderate or severe exacerbation was higher in the high dose ICS group (odds ratios 1.58, 95% CI 1.12 to 2.24 and 1.35, 95% CI 1.10 to 1.66, respectively). For the secondary outcome variables (forced expiratory volume in 1 second, morning and evening peak expiratory flow, and daytime ß agonist use) there was significantly greater benefit in the salmeterol group.
Conclusions: This meta-analysis shows that the addition of salmeterol to moderate doses of ICS (fluticasone 200 µg/day or equivalent) in patients with asthma symptomatic at that dose results in significantly greater clinical benefit than increasing the dose of ICS by twofold or more.
Abbreviations: BDP, beclometasone dipropionate; FEV1, forced expiratory flow in 1 second; ICS, inhaled corticosteroid; LABA, long acting beta agonist; PEF, peak expiratory flow
Keywords: asthma; inhaled corticosteroid; long acting ß agonist; combination treatment
Related Article
Thorax 2005 60: 709a.
This article has been cited by other articles:
|
|
 |
|
  E. Bateman, H. Nelson, J. Bousquet, K. Kral, L. Sutton, H. Ortega, and S. Yancey Meta-analysis: Effects of Adding Salmeterol to Inhaled Corticosteroids on Serious Asthma-Related Events Ann Intern Med, July 1, 2008; 149(1): 33 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Schermer, J. Albers, H. Verblackt, R. Costongs, and P Westers Lower inhaled steroid requirement with a fluticasone/salmeterol combination in family practice patients with asthma or COPD Fam. Pract., April 1, 2007; 24(2): 181 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. S. Nelson and P. M. Dorinsky Safety of long-acting beta-agonists. Ann Intern Med, November 7, 2006; 145(9): 706 - 706. [Full Text] [PDF]
|
|
|
|
 |
|
 J M FitzGerald and P G Gibson Asthma exacerbations {middle dot} 4: Prevention. Thorax, November 1, 2006; 61(11): 992 - 999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Weinberger and M. Abu-Hasan Life-Threatening Asthma during Treatment with Salmeterol N. Engl. J. Med., August 24, 2006; 355(8): 852 - 853. [Full Text] [PDF]
|
|
|
|
|
|
M L Barnes, B J Lipworth, M Weatherall, M Masoli, and R Beasley Clinical importance of the Step 3 choice in asthma Thorax, February 1, 2006; 61(2): 180 - 181. [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Strek Difficult asthma. Proceedings of the ATS, January 1, 2006; 3(1): 116 - 123. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A E Tattersfield When should a long acting {beta} agonist be added to an inhaled corticosteroid? Thorax, September 1, 2005; 60(9): 710 - 710. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
