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Inhaled fluticasone at different doses for chronic asthma
N Adams1, J M Bestall, P W Jones
114 Dewinter House, Granville Road, Sevenoaks, Kent, UK, TN13 1DZ. nadams2001@btinternet.com
The Cochrane Database of Systematic Reviews
|March 1, 2002
Summary
Inhaled fluticasone propionate (FP) shows dose-dependent effects in asthma, with mild-moderate cases achieving similar control at lower doses. Higher FP doses may aid oral corticosteroid reduction in dependent asthmatics.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Medicine
Background:
- Inhaled fluticasone propionate (FP) is a potent inhaled corticosteroid for asthma management.
- Understanding FP's dose-response relationship is crucial for optimizing asthma treatment.
Purpose of the Study:
- To evaluate efficacy and safety of different inhaled fluticasone doses in chronic asthma.
- To determine if a dose-response effect exists for inhaled fluticasone.
Main Methods:
- Systematic review of randomized controlled trials comparing various daily doses of inhaled fluticasone.
- Searched multiple databases and contacted trialists for comprehensive study inclusion.
- Assessed study quality and extracted data for quantitative analysis.
Main Results:
- A dose-response effect was observed for morning peak expiratory flow (PEF) in non-oral steroid-treated patients with mild-moderate asthma.
- Higher doses (800-1000 mcg/d) of FP were associated with increased hoarseness and oral candidiasis compared to lower doses (50-100 mcg/d).
- In oral steroid-dependent asthma, 2000 mcg/d of FP increased the likelihood of stopping prednisolone and reduced daily dosage.
Conclusions:
- Inhaled fluticasone's effects are dose-dependent but modest.
- Mild-to-moderate asthma patients achieve comparable control with low (≤200 mcg/d) and high (≥500 mcg/d) FP doses.
- High-dose FP (2000 mcg/d) may help reduce prednisolone requirements in dependent asthmatics.