Asthma control can be maintained when fluticasone propionate/salmeterol in a single inhaler is stepped down

Bateman, Eric D.; Jacques, Loretta; Goldfrad, Caroline; Atienza, Tito; Mihaescu, Triaian; Duggan, Marie T.

doi:10.1016/j.jaci.2005.11.036

Cited by 83 publications

(63 citation statements)

References 14 publications

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“…Collectively, the studies have supported the notion that stable asthmatic patients on high-dose ICS may be over-treated and that reductions in the inhaled dose can be achieved without worsening disease control [53,54,55,56,57]. …”

Section: Clinical Relevance Of Small-airway-targeted Therapymentioning

confidence: 92%

Treating the Small Airways

Usmani¹

2012

Respiration

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Section: Clinical Relevance Of Small-airway-targeted Therapymentioning

confidence: 92%

Treating the Small Airways

Usmani¹

2012

Respiration

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“…However, this study did not address whether control could be maintained if treatment was reduced. More recent work has suggested that when treatment reduction is indicated it is best to reduce the glucocorticoid dose rather than remove the LABA [134]. Currently, overall, there is no clear clinical evidence that suggests that one drug combination is better than the other in the short term [135] although differences in the device may be important in lung deposition in asthmatic patients with poor inspiratory flow [136] and treatment regimes may benefit some patients over others [125,133,137,138].…”

Section: Moderate Persistent Asthmamentioning

confidence: 99%

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Chung

Caramori

Adcock

2009

Eur J Clin Pharmacol

123

106

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International audienceInhaled corticosteroid (ICS) therapy in combination with long-acting β-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD). ICS therapy forms the basis for treatment of asthma of all severities, improving asthma control, lung function and preventing exacerbations of disease. Use of ICS has also been established in the treatment of COPD, particularly symptomatic patients, who experience useful gains in quality of life, likely from an improvement in symptoms such as breathlessness and in reduction in exacerbations, and an attenuation of the yearly rate of deterioration in lung function. The addition of long-acting β-agonist (LABA) therapy with ICS increases the efficacy of ICS effects in moderate-to-severe asthma. Thus, a 800 μg daily dose of the ICS budesonide reduced severe exacerbation rates by 49% compared to a low dose of 200 μg daily, and addition of the LABA formoterol to budesonide (800 μg) led to a 63% reduction. In COPD, the effects of ICS are less prominent but there are beneficial effects on the decline in FEV and the rate of exacerbations. A reduction in the rate of decline in FEV of 16 ml/year with a 25% reduction in exacerbation rate has been reported with the salmeterol and fluticasone combination. A non-significant 17.5% reduction in all-cause mortality rate with ICS and LABA is reported. Chronic inflammation is a feature of both asthma and COPD, although there are site and characteristic differences. ICS targets this inflammation although this effect of ICS is less effective in patients with severe asthma and with COPD; however, addition of LABA may potentiate the anti-inflammatory effects of ICS. An important consideration is the presence of corticosteroid insensitivity in these patients. Currently available ICS have variably potent binding activities to specific glucocorticoid receptors, leading to inhibition of gene expression by either binding to DNA and inducing anti-inflammatory genes or by repressing the induction of pro-inflammatory mediators. Local side effects of ICS include oral candidiasis, hoarseness and dysphonia, while systemic side effects, such as easy bruising and reduction in growth velocity or bone mineral densitometry, are usually restricted to doses above maximally recommended doses. Use of LABA alone in patients with asthma increases the risk of asthma-related events including deaths, but this is less observed with the combination of ICS and LABA. Therefore, use of LABA alone is not recommended for asthma therapy. Future progress in ICS development will be characterised by the introduction of ICS with greater efficacy with a limited side-effect profile, and by longer-acting ICS that can be used in combination with once-daily LABAs. Other agents that could improve the efficacy of corticosteroids or reverse corticosteroid insensitivity may be added to ICS. ICS in combination with LABAs will continue to remain the main focus of treatment of airways diseases

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“…На сегодняшний день насчитывается по меньшей мере 6 исследований, в которых изучались эффекты деэскалации терапии с переходом от комбинации ИКС/ДДБА к монотерапии ИКС [39][40][41][42][43][44].…”

Section: низкая приверженность регулярной терапии иксunclassified

Early Prescription of Inhalation Corticosteroid in Bronchial Asthma

Айсанов¹,

Калманова²,

Стулова³

2017

Med. sov.

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П о данным разных авторов, от 50 до 75% боль-ных бронхиальной астмой (БА) страдают лег-кой формой заболевания, однако риск обо-стрения не всегда адекватно оценивается [1]. Долго-срочными целями лечения БА, включая легкое течение заболевания, являются контроль симптомов и минимиза-ция рисков будущих обострений, развития фиксирован-ной бронхиальной обструкции и побочных эффектов проводимой терапии [2]. Тем не менее течение астмы во многих случаях не удается контролировать, несмотря на имеющиеся на сегодняшний день в распоряжении врача эффективные лечебные режимы [1,3]. ПАТОФИЗИОЛОГИЧЕСКИЕ И МОЛЕКУЛЯРНЫЕ МЕХАНИЗМЫ КОМБИНИРОВАННОЙ ТЕРАПИИСимптомы БА связаны не только с бронхоконстрикци-ей, но и с воспалением дыхательных путей (ДП) [4][5][6][7][8], и обе группы препаратов -как бета2-агонисты (Б2А), так и ингаляционные кортикостероиды (ИКС) обладают быстрым противовоспалительным действием.Ингаляционные Б2А помимо расслабляющего дей-ствия на гладкую мускулатуру бронхов обладают и небронходилатационными эффектами, что обусловлива-ет их влияние на обострения астмы. Бета-агонисты спо-

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Asthma control can be maintained when fluticasone propionate/salmeterol in a single inhaler is stepped down

Cited by 83 publications

References 14 publications

Treating the Small Airways

Treating the Small Airways

Inhaled corticosteroids as combination therapy with β-adrenergic agonists in airways disease: present and future

Early Prescription of Inhalation Corticosteroid in Bronchial Asthma

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