- Title
- Down-titration from high-dose combination therapy in asthma: removal of long-acting β₂-agonist
- Creator
- Reddel, Helen K.; Gibson, Peter G.; Peters, Matthew J.; Wark, Peter A. B.; Sand, Ingrid B.; Hoyos, Camilla M.; Jenkins, Christine R.
- Relation
- Respiratory Medicine Vol. 104, Issue 8, p. 1110-1120
- Publisher Link
- http://dx.doi.org/10.1016/j.rmed.2010.04.003
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2010
- Description
- Asthma guidelines recommend reducing inhaled corticosteroids (ICS) to the minimum effective dose, but the timing of long-acting β₂-agonist (LABA) withdrawal is unclear. Recent FDA guidelines recommend LABA withdrawal once asthma is well-controlled. This 13-month double-blind study of patients taking high-dose combination therapy investigated the effect of discontinuation of LABA before ICS down-titration. Adults using salmeterol/fluticasone combination (SFC) 50/500 μg bd were randomized to SFC 50/500 μg bd or fluticasone propionate (FP) 500 μg bd, with subsequent ICS down-titration 8-weekly using a clinical algorithm. The primary outcome was mean daily FP dose, including ICS for exacerbations. 82 subjects were randomized. Asthma was well-controlled at baseline, with mean FEV1 84.8% predicted and Asthma Control Questionnaire (ACQ) score 0.9. There was no significant difference in mean daily FP dose (SFC: 721 μg, FP:816 μg, p = 0.3), but final dose was lower with SFC (534 μg cf. 724 μg, p = 0.005). ICS dose was reduced by ≥80% in 41% SFC and 15% FP patients. Ambulatory lung function was significantly higher with SFC, but there were no differences between groups in rescue β₂-agonist use, clinic spirometry, airway responsiveness, ACQ, sputum eosinophils or FeNO. Baseline airway responsiveness, and pre-reduction blood eosinophils, were significant predictors of mean daily FP dose and dose reduction failure respectively. Many patients prescribed high-dose combination therapy may be over-treated. Substantial reductions in dose can be achieved with a clinical algorithm, reaching lower FP doses with SFC than FP without losing asthma control or increasing disease activity. This study was commenced before mandatory registration of clinical trials.
- Subject
- asthma; down-titration; combination ICS/LABA therapy; treatment outcomes
- Identifier
- http://hdl.handle.net/1959.13/930128
- Identifier
- uon:10770
- Identifier
- ISSN:0954-6111
- Language
- eng
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