Inhaled fluticasone proprionate for chronic asthma
Abstract
Background
Inhaled fluticasone propionate (FP) is a relatively new inhaled corticosteroid for the treatment of asthma.
Objectives
1. To assess efficacy and safety outcomes in studies that compared FP to placebo for treatment of chronic asthma.
2. To explore the presence of a dose‐response effect.
Search methods
We searched the Cochrane Airways Group Trial Register (1999), reference lists of articles, contacted trialists and searched abstracts of major respiratory society meetings (1997‐1999).
Selection criteria
Randomised trials in children and adults comparing FP to placebo in the treatment of chronic asthma. Two reviewers independently assessed articles for inclusion and methodological quality.
Data collection and analysis
One reviewer extracted data. Quantitative analyses where undertaken using Review Manager 4.0.3 with MetaView 3.1.
Main results
28 studies were selected for inclusion (5788 subjects). Methodological quality was high. In non‐oral steroid treated asthmatics with mild‐moderate disease FP produced improvements from baseline compared to placebo: FEV1 Weighted Mean Difference (WMD) 0.31 litres (95% confidence interval (CI) 0.27 to 0.36 litres); morning PEF WMD 29 /min (95% CI 24 to 33 L/min); symptom scores Standardised Mean Difference (SMD) 0.59 (95% CI 0.47 to 0.71); reduction in rescue beta2 agonist use WMD 1.1 puffs/d (95% CI 0.9 to 1.4). Similar effects were seen for all doses up to 1000 mcg/d. A shallow dose response effect was apparent: e.g. change in morning PEF with FP 1000 mcg/d WMD 49 L/min (95% CI 41 to 58 L/min). High dose FP reduced the number of patients dependent on prednisolone: FP 1000‐1500 mcg/d Peto Odds Ratio 0.07 (95% CI 0.05 to 0.10). FP at all doses led to a greater likelihood of sore throat, hoarseness and oral Candidiasis.
Authors' conclusions
Doses of FP in the range 100‐1000 mcg/d are effective. Although there appears to be a dose‐response effect, in most patients with mild‐moderate asthma improvements with low dose FP are only a little less than those with high doses. High dose FP appears to have worthwhile oral‐corticosteroid reducing properties. FP use is accompanied by an increased likelihood of oropharyngeal side effects and this appears to be dose dependent.
PICOs
Plain language summary
Fluticasone is a relatively new inhaled steroid for use a preventative agent in controlling asthma symptoms. This review found that it is highly effective even in low doses. The effect does appear to increase with higher doses, but these improvements are small. This drug is associated with symptoms such a thrush, sore throat and hoarseness and these get worse with higher doses. In people with severe asthma who need oral steroid tablets to control their asthma, it can reduce the dose of oral steroids they need and improve their asthma at the same time. High or very high doses are needed for this effect, however.
The drug appears to work in children and adults.
