Fluticasone alone or in combination with salmeterol vs triamcinolone in asthma

Objectives: To compare the efficacies of medium-dose fluticasone propionate (FP), medium-dose triamcinolone acetonide (TAA), and combined low-dose FP plus salmeterol (SL). Design: Randomized, double-blind, triple-dummy, multicenter, re-week clinical trial. Setting: Allergy/respiratory care clinics. Patients: Six hundred eighty patients with asthma previously uncontrolled with low-dose inhaled corticosteroids. Interventions: FP, 220 mu g bid; TAA, 600 mu g bid; or FP, 88 mu g plus SL, 42 mu g bid. Measurements and results: Outcome measures included FEV1, peak expiratory flow (PEF), supplemental albuterol use, nighttime awakenings, asthma symptoms, and physician global assessment. Compared with TAA, 600 pg bid, treatment with FP 220, mu g bid, significantly increased FEV1, morning and evening PEF, and percent symptom-free days, and significantly reduced rescue albuterol use, number of nighttime awakenings, and overall asthma symptom scores (p less than or equal to 0.035). Improvements with low-dose FP, 88 mu g, plus SL, 42 mu g bid, were significantly (p less than or equal to 0.004) greater than TAA, 600 mu g bid, in all the aforementioned efficacy measures as well as percent of rescue-free days. Combined low-dose PP, 88 mu g, plus SL, 42 mu g bid, also significantly increased FEV, and percent of rescue-free days, and significantly reduced albuterol use compared with medium-dose FP, 220 mu g bid (p less than or equal to 0.018). At endpoint, both FP, 220 mu g bid, and FP, 88 mu g, plus SE, 42 mu g bid, significantly increased FEV, by 0.48 L and 0.58 L, respectively, compared with 0.34 L with TAA, 600 mu g bid. Conclusion: In patients who are symptomatic while taking low-dose inhaled corticosteroids, medium-dose FP (440 mu g/d) and combination treatment with low-dose FP (176 mu g/d) plus SL (84 mu g/d) are both more effective than medium-dose TAA (1200 mu g/d) in improving pulmonary function and asthma symptom control.