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Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a
R F Lemanske1, C A Sorkness, E A Mauger
1University of Wisconsin Children's Hospital, 600 Highland Ave, K4/916-9988, Madison, WI 53792, USA. rfl@medicine.wisc.edu
JAMA
|May 23, 2001
Summary
Adding salmeterol to inhaled corticosteroid (ICS) therapy can allow a 50% reduction in ICS dose for persistent asthma. However, completely eliminating ICS therapy leads to significant asthma control loss and is not recommended.
Area of Science:
- Pulmonology
- Clinical Pharmacology
Background:
- Inhaled long-acting beta(2)-agonists (LABAs) are effective add-on therapies for improving asthma control when combined with inhaled corticosteroids (ICS).
- Persistent asthma often requires ongoing management with ICS, but the potential to reduce or eliminate ICS therapy in conjunction with LABA use remains an area of investigation.
Purpose of the Study:
- To evaluate the feasibility of reducing or eliminating inhaled corticosteroid (ICS) therapy in patients with persistent asthma receiving add-on treatment with a long-acting beta(2)-agonist (LABA).
Main Methods:
- A 24-week, randomized, double-dummy, parallel-group trial involving 175 patients with persistent asthma suboptimally controlled on inhaled triamcinolone acetonide.
- Patients received add-on salmeterol xinafoate, with subsequent randomization to either reduce ICS by 50% then eliminate it, or continue standard ICS therapy (active control).
- The primary outcome measure was time to asthma treatment failure.
Main Results:
- Reducing ICS by 50% in patients receiving salmeterol showed a trend towards increased treatment failure (8.3%) compared to the active control group (2.8%) after 8 weeks.
- Complete elimination of ICS therapy in the salmeterol group resulted in a significantly higher rate of treatment failure (46.3%) compared to the active control group (13.7%) after 8 weeks.
- The relative risk of treatment failure after ICS elimination was 4.3 times higher in the reduced-dose group compared to the active control group (P<.001).
Conclusions:
- A 50% reduction in inhaled corticosteroid (ICS) dose is possible for patients with persistent asthma whose symptoms improve with the addition of salmeterol, without significant loss of asthma control.
- Complete elimination of ICS therapy in this patient population leads to a significant deterioration in asthma control and is not advisable.
- These findings support a strategy of ICS dose reduction rather than elimination when adding LABAs for asthma management.
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