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Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study
Eric D Bateman1, Homer A Boushey, Jean Bousquet
1UCT Lung Institute, P.O. Box 34560, Groote Schuur 7937, Cape Town, South Africa. ebateman@uctgsh1.uct.ac.za
Summary
Achieving guideline-based asthma control is possible for most patients. Salmeterol/fluticasone demonstrated superior efficacy over fluticasone in achieving total and well-controlled asthma, with faster results and lower corticosteroid doses.
Area of Science:
- Pulmonology
- Clinical Trials
- Respiratory Medicine
Background:
- Asthma control, as defined by clinical guidelines, is often not achieved by most patients.
- Prospective studies evaluating the achievability of guideline-defined asthma control are limited.
Purpose of the Study:
- To prospectively evaluate the efficacy of salmeterol/fluticasone versus fluticasone in achieving guideline-based asthma control.
- To compare the speed of achieving control and the required corticosteroid dosage between the two treatment groups.
Main Methods:
- A 1-year, randomized, stratified, double-blind, parallel-group study involving 3,421 patients with uncontrolled asthma.
- Patients received either fluticasone propionate or salmeterol/fluticasone, with treatment stepped-up to achieve total control or maximum corticosteroid dosage.
- Asthma control was assessed using two composite, guideline-based measures: totally controlled and well-controlled asthma.
Main Results:
- Significantly more patients achieved total asthma control with salmeterol/fluticasone (41%) compared to fluticasone (28%) at 1 year (p < 0.001).
- Well-controlled asthma was achieved in 71% of patients on salmeterol/fluticasone versus 59% on fluticasone at 1 year (p < 0.001).
- Control was achieved more rapidly and at lower corticosteroid doses with salmeterol/fluticasone; exacerbation rates and health status improvements were also significantly better.
Conclusions:
- Guideline-derived asthma control is achievable in a majority of patients with uncontrolled asthma.
- Salmeterol/fluticasone is more effective than fluticasone in achieving and maintaining asthma control, offering faster results and requiring lower corticosteroid doses.