Serious Asthma Events with Fluticasone plus Salmeterol versus Fluticasone Alone

Stempel, David A.; Raphiou, Ibrahim; Kral, Kenneth M.; Yeakey, Anne; Emmett, Amanda; Prazma, Charlene M.; Buaron, Kathleen S.; Pascoe, Steven

doi:10.1056/nejmoa1511049

Cited by 150 publications

(111 citation statements)

References 25 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…The add-on therapy with salmeterol resulted in significantly more favorable outcomes in terms of PEF change from baseline, the need for rescue medication, and the number of symptom-free days [76,77]. Recent multicenter, randomized, double-blind studies showed that treatment with budesonide/formoterol and fluticasone/salmeterol were associated with a lower risk of asthma exacerbations than budesonide alone and fluticasone alone groups respectively [78,79]. There have been concerns about the safety of LABA use in patients with asthma [80,81], but patients who received the ICS/LABA combination preparations did not have a significantly higher risk of serious asthma-related events than did those who received ICS alone.…”

Section: Safety and Efficacymentioning

confidence: 99%

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

D’Urzo

2017

Pulm Ther

View full text Add to dashboard Cite

Asthma is a chronic inflammatory disease characterized by symptoms of cough, dyspnea, chest tightness, and wheeze. Inhaled corticosteroids (ICS) have been recommended as initial therapy in the treatment of persistent asthma in all guidelines, as they have been shown to reduce morbidity and mortality. However, high-dose regimens and long-term use of ICS may be associated with a variety of side effects, similar to those observed with systemic corticosteroid therapy. These side effects include impaired growth in children, osteoporosis, fractures, glaucoma, cataracts, and skin thinning. The current recommendations on ICS use in asthma management will be reviewed in this article with a view to highlight treatment strategies that strike an optimal balance between safety and efficacy.

show abstract

Section: Safety and Efficacymentioning

confidence: 99%

A Review on the Safety and Efficacy of Inhaled Corticosteroids in the Management of Asthma

D’Urzo

2017

Pulm Ther

View full text Add to dashboard Cite

show abstract

“…62 The risk of asthma exacerbation was significantly reduced in patients who continued ICS-LABA (hazard ratio 0.76, 0.65 to 0.91). Of note, the results from these studies are derived primarily from adults.…”

Section: Summary Of Step-down Choicesmentioning

confidence: 98%

Why and how to step down chronic asthma drugs

Gionfriddo

Hagan

Rank

2017

BMJ

View full text Add to dashboard Cite

Asthma is a common chronic airways disease. The goal of asthma management is to control symptoms while minimizing the side effects of treatment. Following a period of stable asthma, clinicians should consider stepping down treatment. This approach is recommended by current guidelines. Step-down has been studied for several types of asthma drug regimens, and certain approaches may have lower risk than others. Systematic reviews of multiple trials support the following specific step-down approaches: optimizing inhaled corticosteroid dosing when stepping down oral corticosteroid, reducing inhaled corticosteroid from a higher dose, lowering inhaled corticosteroid-long acting bronchodilator (ICS-LABA) dose while adding ICS-LABA on-demand, adding leukotriene receptor antagonist (LTRA) while lowering inhaled corticosteroid dose, and using allergen immunotherapy when reducing inhaled corticosteroid from a higher dose. Systematic reviews of multiple trials support an increased risk of asthma exacerbation for patients who completely stop taking inhaled corticosteroid or long acting bronchodilator. Strategies to implement step-down in practice include the use of risk prediction as well as tools to support shared decision making and communication about risk between clinicians and patients.

show abstract

“…However, contrary to expectations, adding a long-acting beta 2 agonist has surprisingly little effect on the use of reliever inhalers. 9 After asthma has been well-controlled for 2-3 months, treatment can be gradually stepped down to find the patient's minimum effective dose.…”

Section: Book a Review Visit If Treatment Has Been Started Or Changedmentioning

confidence: 99%