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Once-daily, High-dose Inhaled Fluticasone Propionate in Patients having Moderate Asthma

Institute of Medical Sciences, BHU, Varanasi, India

PURPOSE: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, but are underprescribed and their effectiveness is compromised by low patient compliance. Current ICS are recommended for use 2 or more times per day, making compliance problematic. The current study assessed the compliance and efficacy of once-daily inhaled fluticasone propionate in Indian patients of Eastern Uttar Pradesh having moderate asthma.

METHODS: The efficacy of inhaled fluticasone propionate (FP) at a dose of 500 µg and salmeterol 50 µg once a day was compared with fluticasone propionate 250 µg and salmeterol 50 µg twice a day in moderate asthma. A total of 280 asthmatics aged 16 to 45 years were randomized to receive either fluticasone with salmeterol once a day or FP with salmeterol twice a day for 3 months by accuhaler.During the study, the patients were recorded morning and evening peak expiratory flow (PEF), symptom score and use of rescue salbutamol. Pulmonary function parameters were measured at the beginning of the study after the first, fourth, eighth and twelve weeks.

RESULTS: At the end of twelve weeks, in comparison with FP + salmeterol once a day resulted in higher FEV1/FVC (p=0.016) and lower diurnal variability of PEF (p=0.038). The number of puffs of rescue salbutamol was also significantly lower. Compliance at the end of therapy was 84% in once daily therapy as compared to 48% in twice a day treatment ( p<0.001).

CONCLUSION: Using a once-daily fluticasone increases effectiveness of asthma treatment as compared to twice a day treatment.

CLINICAL IMPLICATIONS: Once-daily fluticasone may be tried in patients having moderate asthma to improve compliance and to improve efficacy of asthma treatment.

DISCLOSURE: S.K. Agarwal, None.