Difficult asthma can often be well controlled

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Most people with uncontrolled asthma can achieve good control over their disease using a combination of the inhaled steroid fluticasone and the long-acting beta-2-agonist salmeterol, according to a study supported by GlaxoSmithKline R&D Limited.

Glaxo produces the combination product used in the study, marketed as Advair or Seretide.

"This approach should be the preferred treatment selection for patients whose asthma is uncontrolled, regardless of their previous inhaled corticosteroid regimen,” Dr. Eric D. Bateman from the University of Cape Town in South Africa and an international team conclude in the report, which is published in the American Journal of Respiratory and Critical Care Medicine.

Some 3,400 patients with uncontrolled asthma were randomly assigned to fluticasone alone or the combination of fluticasone and salmeterol for one year.

Overall, significantly more patients achieved control with fluticasone/salmeterol than with fluticasone alone. In addition, asthma control was achieved more rapidly and at a lower corticosteroid dose with the salmeterol/fluticasone combination than with fluticasone alone.

Total control of asthma, defined as the complete absence of all features of asthma for at least 7 of 8 weeks, was achieved by 41 percent of those using salmeterol/fluticasone versus 28 percent of those using only fluticasone, after one year.

“Well-controlled” asthma was achieved by 71 percent of previously untreated subjects on salmeterol/fluticasone versus 65 percent of like subjects on fluticasone alone. The percentages were slightly lower for participants who had been treated with steroids previously.

These results suggest that total control of asthma “should be the aim of treatment for all asthma patients,” Bateman and colleagues charge.

In an editorial, Dr. Neil C. Barnes from the UK’s London Chest Hospital worries that the “high compliance achieved in the study may be irreproducible in practice.” More research will be required to “bridge the gap between what can be achieved in a trial and what occurs in practice,” he writes.

SOURCE: American Journal of Respiratory and Critical Care Medicine, October 15, 2004.

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