Fluticasone Versus Salmeterol

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Fluticasone Versus Salmeterol/Low-Dose Fluticasone for

Long-Term Asthma Control

The ls of Pharmacotherapy: Vol. 36, No. 12, pp.

1944–1949

A Heyneman, Crafts, Jerry Holland,

and D Arnold

OBJECTIVE: To evaluate the relative clinical

superiority of increasing the dose of fluticasone

propionate versus the addition of salmeterol to

low-dose fluticasone propionate for long-term asthma

control.

DATA SOURCES: Literature was identified by a MEDLINE

search (1966–October 2002). Key search terms included

asthma, inhalation, corticosteroid,  -adrenergic

agonist, and combination drug therapy.

DATA SYNTHESIS: Current guidelines for long-term

control of asthma include treatment with either

inhaled corticosteroids (medium dose) or inhaled

corticosteroids (low to medium dose) in combination

with a long-acting bronchodilator. Previous studies

evaluating salmeterol or formoterol combination

therapy with beclomethasone or budesonide have

generally produced superior results compared with

increasing the dose of the inhaled corticosteroid.

Four recent controlled clinical trials have compared

the clinical utility of fluticasone propionate

monotherapy versus salmeterol/low-dose fluticasone

propionate for long-term asthma control in patients

with moderate to severe persistent asthma. Based on

spirometry data, rescue albuterol use, and symptom

scores, the addition of salmeterol to low-dose

fluticasone propionate was superior to increasing the

dose of fluticasone propionate.

CONCLUSIONS: Based on improvements in forced

expiratory volume in 1 second, peak expiratory flow,

and symptom control, the addition of salmeterol to

low-dose fluticasone propionate provides better

control of asthma than increasing the dose of

fluticasone propionate.

Becki

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