Can guideline-defined asthma control be achieved? The gaining optimal asthma control study

被引:1264
作者
Bateman, ED
Boushey, HA
Bousquet, J
Busse, WW
Clark, TJH
Pauwels, RA
Pedersen, SE
机构
[1] UCT Lung Inst, ZA-7937 Cape Town, South Africa
[2] Univ Calif San Francisco, San Francisco, CA 94143 USA
[3] Hop Arnaud De Villeneuve, Montpellier, France
[4] Univ Wisconsin, Sch Med, Madison, WI USA
[5] Ghent Univ Hosp, Ghent, Belgium
[6] Univ London Imperial Coll Sci Technol & Med, London, England
[7] Univ So Denmark, Kolding, Denmark
关键词
antiasthmatic agents; fluticasone propionate; guidelines; quality of life; salmeterol;
D O I
10.1164/rccm.200401-033OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
For most patients, asthma is not controlled as defined by guidelines; whether this is achievable has not been prospectively studied. A 1-year, randomized, stratified, double-blind, parallel-group study of 3,421 patients with uncontrolled asthma compared fluticasone propionate and salmeterol/fluticasone in achieving two rigorous, composite, guideline-based measures of control: totally and well-controlled asthma. Treatment was stepped-up until total control was achieved (or maximum 500 mug corticosteroid twice a day). Significantly more patients in each stratum (previously corticosteroid-free, low- and moderate-dose corticosteroid users) achieved control with salmeterol/fluticasone than fluticasone. Total control was achieved across all strata: 520 (31%) versus 326 (19%) patients after dose escalation (p<0.001) and 690 (41%) versus 468 (28%) at 1 year for salmeterol/fluticasone and fluticasone, respectively. Asthma became well controlled in 1,071 (63%) versus 846 (50%) after dose escalation (p<0.001) and 1,204 (71%) versus 988 (59%) at 1 year. Control was achieved more rapidly and at a lower corticosteroid dose with salmeterol/fluticasone versus fluticasone. Across all strata, 68% and 76% of the patients receiving salmeterol/fluticasone and fluticasone, respectively, were on the highest dose at the end of treatment. Exacerbation rates (0.07-0.27 per patient per year) and improvement in health status were significantly better with salmeterol/fluticasone. This study confirms that the goal of guideline-derived asthma control was achieved in a majority of the patients.
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页码:836 / 844
页数:9
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