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Step-down compared to fixed-dose treatment with inhaled fluticasone propionate in asthma.
Chest 2005; 127(1):117-24Chest

Abstract

BACKGROUND

Inhaled corticosteroids (ICSs) are an effective treatment of asthma even when administered at a low dose. Once asthma is controlled, current guidelines recommend that the dose of ICS be reduced to the lowest possible and effective dose. Although the most appropriate strategy for the stepping down has not yet been defined, quantification of sputum eosinophils and bronchial hyperresponsiveness (BHR) are indeed measures of asthma control.

OBJECTIVE

To compare the efficacy of step-down and fixed-dose strategies in the control of BHR to methacholine and eosinophilic inflammation patients with mild-to-moderate asthma.

METHODS

We performed a double-blind, randomized study to compare inhaled fluticasone propionate (FP), 1,000 microg/d, then reduced to 200 microg/d (group 1; n = 18) to a fixed dose of FP, 200 microg/d (group 2; n = 17) administered for 6 weeks and then 8 weeks in reducing the provocative dose of methacholine causing a 20% fall in FEV1 (PD20) and sputum eosinophils in 35 patients. The duration of the efficacy was also followed subsequently after 8 weeks of placebo treatment.

RESULTS

PD20 remarkably increased with both treatment strategies, but differences between groups were not significant. Sputum eosinophils (median values, percentage) at baseline and after each treatment period were not different (group 1, 16.4 to 1.0 to 2.7%; group 2, 16.7 to 2.8 to 2.8%, respectively). The percentages of patients in whom sputum eosinophilia was normalized (< or = 3%) were as follows: group 1, 69% and 60%; group 2, 50% and 57%. After placebo treatment, sputum eosinophils were still "normalized" in approximately one third of patients.

CONCLUSION

Step-down and fixed-dose strategies with FP improved PD20 and sputum eosinophilia to a similar degree. The effect on sputum eosinophils persisted longer than that on methacholine.

Authors+Show Affiliations

Respiratory Pathophysiology Unit, Sesto San Giovanni Hospital, Sesto San Giovanni, Italy. antonio.foresi@aovimercate.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15653971

Citation

Foresi, Antonio, et al. "Step-down Compared to Fixed-dose Treatment With Inhaled Fluticasone Propionate in Asthma." Chest, vol. 127, no. 1, 2005, pp. 117-24.
Foresi A, Mastropasqua B, Chetta A, et al. Step-down compared to fixed-dose treatment with inhaled fluticasone propionate in asthma. Chest. 2005;127(1):117-24.
Foresi, A., Mastropasqua, B., Chetta, A., D'Ippolito, R., Testi, R., Olivieri, D., & Pelucchi, A. (2005). Step-down compared to fixed-dose treatment with inhaled fluticasone propionate in asthma. Chest, 127(1), pp. 117-24.
Foresi A, et al. Step-down Compared to Fixed-dose Treatment With Inhaled Fluticasone Propionate in Asthma. Chest. 2005;127(1):117-24. PubMed PMID: 15653971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Step-down compared to fixed-dose treatment with inhaled fluticasone propionate in asthma. AU - Foresi,Antonio, AU - Mastropasqua,Berardino, AU - Chetta,Alfredo, AU - D'Ippolito,Raffaele, AU - Testi,Renato, AU - Olivieri,Dario, AU - Pelucchi,Andrea, PY - 2005/1/18/pubmed PY - 2005/2/23/medline PY - 2005/1/18/entrez SP - 117 EP - 24 JF - Chest JO - Chest VL - 127 IS - 1 N2 - BACKGROUND: Inhaled corticosteroids (ICSs) are an effective treatment of asthma even when administered at a low dose. Once asthma is controlled, current guidelines recommend that the dose of ICS be reduced to the lowest possible and effective dose. Although the most appropriate strategy for the stepping down has not yet been defined, quantification of sputum eosinophils and bronchial hyperresponsiveness (BHR) are indeed measures of asthma control. OBJECTIVE: To compare the efficacy of step-down and fixed-dose strategies in the control of BHR to methacholine and eosinophilic inflammation patients with mild-to-moderate asthma. METHODS: We performed a double-blind, randomized study to compare inhaled fluticasone propionate (FP), 1,000 microg/d, then reduced to 200 microg/d (group 1; n = 18) to a fixed dose of FP, 200 microg/d (group 2; n = 17) administered for 6 weeks and then 8 weeks in reducing the provocative dose of methacholine causing a 20% fall in FEV1 (PD20) and sputum eosinophils in 35 patients. The duration of the efficacy was also followed subsequently after 8 weeks of placebo treatment. RESULTS: PD20 remarkably increased with both treatment strategies, but differences between groups were not significant. Sputum eosinophils (median values, percentage) at baseline and after each treatment period were not different (group 1, 16.4 to 1.0 to 2.7%; group 2, 16.7 to 2.8 to 2.8%, respectively). The percentages of patients in whom sputum eosinophilia was normalized (< or = 3%) were as follows: group 1, 69% and 60%; group 2, 50% and 57%. After placebo treatment, sputum eosinophils were still "normalized" in approximately one third of patients. CONCLUSION: Step-down and fixed-dose strategies with FP improved PD20 and sputum eosinophilia to a similar degree. The effect on sputum eosinophils persisted longer than that on methacholine. SN - 0012-3692 UR - https://www.unboundmedicine.com/medline/citation/15653971/Step_down_compared_to_fixed_dose_treatment_with_inhaled_fluticasone_propionate_in_asthma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(15)32380-1 DB - PRIME DP - Unbound Medicine ER -