The Pharmaceutical Journal
Vol 270 No 7251 p742
31 May 2003

This article
Reprint
Photocopy

News summary

Conference summaries  24 May   31 May  

Related websites
American Thoracic Society conference 2003 (more)

Improved control and compliance with compound inhaler for asthma patients

Using an inhaler containing fluticasone propionate and salmeterol (Seretide) results in better control of asthma than using separate inhalers, countering scepticism over the place of compound inhalers in asthma therapy. Two 12-week double blind studies (n=705), presented this week at the American Thoracic Society conference, compared the effects of fluticasone propionate and salmeterol in one inhaler with equal doses of the two drugs in separate inhalers. They show that use of the compound inhaler produced a morning peak expiratory flow (PEF) rate of 13L/min above the value expected from adding the improvement seen with salmeterol alone to that seen with fluticasone alone.

Dr Sanjay Aggarwal, clinical development physician for GlaxoSmithKline, told The Journal that although a 15L/min increase in PEF is usually accepted as the threshold over which patients perceive benefit, 13L/min was a good improvement and higher than in previous studies. "A combination inhaler allows both drugs to be deposited in the same place rather than one at the top and the other at the bottom of the lungs," Dr Aggarwal said.

Other studies presented at the conference indicate that use of the compound inhaler improved both control and compliance. Control was gauged using the number of short-acting b2-agonist inhalers prescribed. Prescribing data for 6,346 patients were analysed. Patients prescribed an inhaler containing fluticasone and salmeterol together were prescribed a mean of 4.5 (SD=5.5) short-acting bronchodilators in one year compared with 6.1 (SD=6.4) prescribed in the group prescribed separate salmeterol and fluticasone inhalers (P= 0.0001).

Using a similar technique, another study looked at compliance with asthma therapy in 3,094 children. Compliance was measured on the premise that if the patient collected prescriptions for all the asthma therapy he or she was expected to use in a year, compliance would be 100 per cent. Researchers reported that patients prescribed the compound inhaler (n=94) were 72.5 per cent compliant compared with those who were prescribed two separate inhalers or fluticasone only (55.8 and 55.0 per cent, respectively, P=0.0005 and <0.0001, respectively).

Dr Paul McCarthy, associate medical director for GSK told The Journal "By the next revision of the asthma guidelines, this evidence will be published and hopefully it will be taken into account. If I had to make a bet, in the future, combination inhalers will be first-line therapy."

The Journal attended the American Thoracic Society's 99th international conference in Seattle, Washington, courtesy of GlaxoSmithKline