Optimal step-down approach for pediatric asthma controlled by salmeterol/fluticasone: A randomized, controlled trial...

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Clinical Pharmacy

Background:

• Salmeterol/fluticasone combination (SFC) therapy is recommended for moderate to severe pediatric asthma.
• Optimal strategies for stepping down SFC treatment in children remain unclear.
• This study investigated step-down approaches in children stabilized on SFC.

Purpose of the Study:

• To evaluate the efficacy of two different step-down strategies for SFC in pediatric asthma.
• To compare respiratory function and airway inflammation markers after step-down therapy.

Main Methods:

• A 12-week, randomized, multicenter study in children aged 5-15 years.
• Participants were assigned to either reduced-dose SFC (25/50 μg b.i.d.) or fluticasone propionate (FP) alone (100 μg b.i.d.).
• Childhood Asthma Control Test (C-ACT) scores, lung function, and exhaled nitric oxide (FeNO) were monitored.

Main Results:

• 128 of 131 subjects completed the study.
• The FP group showed decreases in % peak expiratory flow rate and % forced expiratory flow at 50% vital capacity (V50).
• No significant changes in FeNO or C-ACT scores were observed within or between groups.

Conclusions:

• Both step-down approaches maintained a high level of asthma control.
• SFC step-down showed slightly better respiratory function without increased airway inflammation.
• Reducing SFC dosage or switching to FP alone are both viable step-down options.