Treatment strategies for people with mild asthma examined
Strategies to treat mild asthma are the subject of two studies published
in The New England Journal of Medicine (2007;356:2027 and
2040).
The first examined whether 500 patients with asthma who were well controlled
on inhaled fluticasone 100µg twice daily could receive a step down
treatment to once daily fluticasone 100µg plus salmeterol 50µg,
or once daily oral montelukast 5mg or 10mg.
The researchers found that about 30 per cent of patients who changed
to montelukast experienced treatment failure, compared with around 20
per cent of those who continued on fluticasone or changed to fluticasone
plus salmeterol (hazard ratio 1.6, 95 per cent confidence interval 1.1–2.6;
P=0.03).
The percentage of symptom free days was similar across the three groups
(range 78.7 to 85.8 per cent). They conclude that patients can be safely
stepped down to once daily fluticasone/salmeterol treatment. Montelukast
is not as effective, although it provided good asthma control for most
patients, they say.
The second study investigated whether symptom-driven use of a combination
inhaler containing beclometasone diproprionate 250µg and salbutamol
100µg is as effective as regular beclometasone 250µg twice
daily, and superior to as-needed salbutamol 100µg, in 455 patients
with mild asthma.
“The symptom-driven use of inhaled beclometasone and salbutamol
in a single inhaler is as effective as regular use of inhaled beclometasone
and is
associated with a lower six-month cumulative dose of the inhaled corticosteroid,” they
say. The as-needed combination therapy group saw better morning peak
expiratory flow rates (P=0.04) and fewer exacerbations (P=0.002)
than the as-needed salbutamol group.
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