Asthma inhaler ‘step-down’ may be unnecessary

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Starting people with moderate asthma on a high dose of the inhaled steroid fluticasone and then stepping down to a low dose is no more effective than starting with at a low fixed dose, according to a study conducted in Italy.

“Our results, together with previous findings, strongly suggest that the step-down or ‘hit-hard’ approach may not be necessary in patients with mild-to-moderate asthma” to control inflammation, Dr. Antonio Foresi from Sesto San Giovanni Hospital and colleagues write in the journal Chest.

Foresi’s team randomly assigned 35 such patients to start inhaled fluticasone propionate at 1000 micrograms per day and then to reduce the dose to 200 micrograms per day, or to start treatment at a fixed-dose of 200 micrograms.

The investigators report that both approaches reduced bronchial hyperresponsiveness and airway inflammation to a similar degree.

Moreover, 8 weeks after stopping fluticasone, markers of inflammation remained in the normal range in 30 percent of patients in both groups.

Fluticasone is the steroid used in Advair and Flovent inhalers made by Glaxo, which provided a grant for the study.

SOURCE: Chest, January 2005.

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