ASTHMA

Clinical dose-response relationship of fluticasone propionate in adults with asthma

M Masoli¹, M Weatherall², S Holt³, R Beasley^1,4

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, PO Box 10055, Wellington 6001, New Zealand; richard.beasley{at}mrinz.ac.nz

Background: A study was undertaken to examine the dose-response relation of inhaled fluticasone in adolescents and adults with asthma.

Methods: A meta-analysis was carried out of randomised clinical trials that presented data on at least one outcome measure of asthma and that used at least two doses of fluticasone given twice daily. The main outcome measures were forced expiratory volume in 1 second (FEV₁), morning peak expiratory flow (amPEF), ß agonist use, and withdrawals due to exacerbations of asthma.

Results: Seven studies of 2431 adolescents and adults with moderate to severe asthma met the inclusion criteria for the meta-analysis. Four studies examined a dose of >500 µg/day. For all outcome measures there were no statistically significant differences between a dose of 200 v 500 µg/day, 500 v 1000 µg/day, and 200 v 500 µg/day, although the point estimates favoured the higher doses. The mean improvement for FEV₁ and amPEF resulting from an increase in dose from 200 to 500 µg/day was 0.07 l (95% CI -0.01 to 0.14) and 5.9 l/min (95% CI -3.0 to 15.3), respectively. The odds ratio for withdrawals with 200 µg/day compared with 500 µg/day was 1.27 (95% CI 0.78 to 2.07).

Conclusions: In adolescents and adults with asthma, most of the therapeutic benefit of fluticasone is achieved with a total daily dose of 200 µg/day with minimal further clinical benefit achieved with higher doses. This conclusion is qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids in asthma, which would suggest that some patients may obtain a greater clinical benefit at higher doses.

Keywords: asthma; inhaled corticosteroids; fluticasone; dose-response

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Airwaves

Wisia Wedzicha
Thorax 2004 59: 1. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Wechsler, M. E. (2009). Managing Asthma in Primary Care: Putting New Guideline Recommendations Into Context. Mayo Clin Proc. 84: 707-717 [Abstract] [Full Text]  
• Ernst, P., McIvor, A., Ducharme, F. M., Boulet, L.-P., FitzGerald, M., Chapman, K. R., Bai, T., for the Canadian Asthma Guideline Group, (2006). Safety and effectiveness of long-acting inhaled beta-agonist bronchodilators when taken with inhaled corticosteroids.. ANN INTERN MED 145: 692-694 [Abstract] [Full Text]  
• Masoli, M., Weatherall, M., Holt, S., Shirtcliffe, P., Beasley, R. (2006). Inhaled fluticasone propionate and adrenal effects in adult asthma: systematic review and meta-analysis. Eur Respir J 28: 960-967 [Abstract] [Full Text]  
• Vogelmeier, C., D'Urzo, A., Pauwels{dagger}, R., Merino, J. M., Jaspal, M., Boutet, S., Naya, I., Price, D. (2005). Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option?. Eur Respir J 26: 819-828 [Abstract] [Full Text]  
• Masoli, M, Weatherall, M, Holt, S, Beasley, R (2005). Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Thorax 60: 730-734 [Abstract] [Full Text]  
• Masoli, M, Weatherall, M, Beasley, R (2005). Optimal starting dose of inhaled corticosteroids in adult asthma: why has it taken so long?. Thorax 60: 93-94 [Full Text]  
• Reddel, H.K. (2004). Goals of asthma treatment: how high should we go?. Eur Respir J 24: 715-717 [Full Text]