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Effect of addition of salmeterol versus doubling the dose of fluticasone propionate on specific airway resistance in children with asthma

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Abstract:

Based primarily on extrapolation from adult studies, current pediatric asthma guidelines advise the addition of long-acting beta2-agonists for children symptomatic on low/moderate-dose inhaled corticosteroids before increasing the corticosteroid dose. This study was designed to compare the effect of combination salmeterol/fluticasone propionate (SFC) with doubling the dose of fluticasone propionate (FP) on specific airway resistance (sRaw) in moderate/severe persistent asthmatic children. A double-blind, randomized, controlled study was performed; children with asthma (4‐11 years old; sRaw > 1.3 kPa·s) were randomized after a 2-week run-in (FP, 100 g, b.i.d.) to either SFC (50 g/100 g b.i.d.) or FP (200 g b.i.d.) via Diskus (GlaxoSmithKline, Stockley Park, U.K.) for 6 weeks. Lung function (sRaw-plethysmography and forced expiratory volume in 1 second [FEV1]) was measured before run-in, at randomization, after 3 weeks, at the end of 6-week treatment, and after 48-hour washout. Symptom scores and rescue medication use were recorded throughout. Thirty-five children entered run-in and 24 were randomized (mean age, 7.3 ± 2.2 years; 50% boys). All children showed an improvement in sRaw. After adjusting for age, gender, and baseline sRaw, children receiving SFC had a significantly greater improvement in sRaw compared with those receiving FP (adjusted means ratio [95% confidence interval {CI}], 0.81 [0.68‐0.97]; p = 0.021). There was a significant interaction between treatment and gender (sRaw, adjusted geometric mean [95% CI ]kPa·s, SFC versus FP: boys, 1.25 [1.10‐1.41] [n = 7] versus 1.87 [1.61‐2.17] [n = 5]; girls, 1.29 [1.10‐1.52] [n = 5] versus 1.29 [1.13‐1.47] [n = 7]; p = 0.008). There were no differences in FEV1, symptoms, or rescue medication use between the groups. Addition of salmeterol provides greater improvement in sRaw than doubling the dose of FP in children with moderate/severe persistent asthma.

Keywords: Fluticasone/salmeterol combination; plethysmography; pulmonary function test; whole body

Document Type: Research Article

DOI: https://doi.org/10.2500/aap.2010.31.3362

Affiliations: The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research (NIHR) Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester National Health Service (NHS) Foundation Trust, Manchester, UK

Publication date: 2010-09-01

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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