Clinical Question: Is guideline-dri...

Clinical Question: Is guideline-driven care of patients with asthma using stepwise increases in salmeterol-fluticasone therapy more effective than using fluticasone alone?

Setting: Outpatient (any)

close attention Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: This year-long cogitation involved 3,421 patients between 12 and 80 years of age who had at least a six-month history of asthma, had fewer than 10 pack-years of tobacco use, and had not used oral or long-acting beta agonists in the brace weeks before enrollment. The reflection began with a four-week run-in period during which patients continued their usual treatment.

Patients without brace well-controlled weeks were randomized (concealment of allocation not described) to receive salmeterol-fluticasone or fluticasone propionate alone. Each treatment form into groups also was stratified according to the use of inhaled corticosteroids for the six month before enrollment In this phase, dosages of medication were increased until asthma was totally controll or until maximum dosages of medication were used (i.e., salmeterol-fluticasone, 50/500 mcg twice a day; fluticasone, 500 mcg twice a day). The patients then were maintained forward the dosage needed to achieve total hinder (or the maximum dose) for the stillness of the year.

Total asthma regulate was defined as seven of eight weeks with no daytime symptoms; no use of retake medications; a morning peak expiratory stream of at least 80 percent of predicted; and no nighttime awakenings, no exacerbations, no pressing necessity department visits, and no adverse incidents related to the medication. Well-controlled asthma was defined similarly, with the exception of as follows: no more than couple days with a symptom score higher than 1 and the use of recapture medication on no more than sum of two units days and no more than four doses by week. These definitions came from the Global Initiative for Asthma and the National Institutes of Health. The primary meditation objective, assessed by intention to treat, was to determine the proportion of patients who achieved well-controlled asthma.

Significant improvement was noted in the collection receiving salmeterol-fluticasone compared with the form into groups receiving fluticasone alone throughout all phases of the close attention regardless of their baseline steroid use. the same concern of this study, however, was that the guidelines called for an automatic dosage escalation of outcomes manufactured by the study sponsor to achieve total asthma control

Bottom Line: Patients with asthma who are treated with stepwise increases in salmeterol-fluticasone are more likely to achieve total have the direction of or be well controlled through the end of 12 weeks and at the conclusion of one year than patients using fluticasone alone. (Level of Evidence: 1b)

close attention Reference: Bateman ED, et al. Can guideline-defined asthma superintendence be achieved? The Gaining Optimal Asthma regulate Study. Am J Respir Crit Care M October 15 2004;170:836-44

Used with permission from Barry H Salmeterol + fluticasone better than fluticasone in asthma reign over Accessed online November 24, 2004 at: http://www.InfoPOEMs.com.

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