Fixed Versus Adjustable Therapy - Which is Most Effective?
For patients with moderate to severe asthma, combination therapy with inhaled corticosteroids (ICS) and long-acting ß-agonists is considered the preferred treatment by guidelines. More recently, evidence has focused on adjustable dosing of combination therapy to maintain and achieve asthma control, a result accomplished with lower doses of inhaled corticosteroids. To evaluate the effectiveness of such a therapeutic approach in asthma, Busse and coworkers designed a randomized, open-label study in which selected asthma patients were initially treated and stabilized with fixed doses of fluticasone/salmeterol (250/50 mcg) or budesonide/formoterol (320/9 mcg) twice daily. Following this run-in period, eligible patients were either maintained on their fluticasone/salmeterol combination or placed in a budesonide/formoterol arm that consisted of either budesonide/formoterol 320/9 mcg twice daily or budesonide/formoterol330/ 9 mcg once daily with additional dosing when symptoms increased. The primary endpoint was asthma control as assessed by asthma exacerbations. All regimens performed equally well, however, overall inhaled corticosteroid dosing was less with the adjustable approach. Under these conditions, asthma patients were controlled effectively and safely with adjustable therapy further supporting the potential use of this approach.
"Comparison of Adjustable- and Fixed-Dose Budesonide/Formoterol pMDI and Fixed-Dose Fluticasone Propionate/Salmeterol DPI in Asthma Patients"
See original article: AAAAI News (JACI June 2008 Volume 121 No. 6) www.aaaai.org
