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Evidence summaries

Inhaled Fluticasone Propionate for Asthma

Doses of fluticasone in the range of 100 µg to 1000 µg are more effective than placebo in the treatment of asthma. There is no pronounced dose response in FEV1 but morning PEF values may be improved with increasing doses of fluticasone. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 86 studies with a total of 16 160 subjects. Methodological quality was high. In non-oral steroid treated asthmatics with mild and moderate disease fluticasone propionate (FP) resulted in improvements from baseline compared with placebo across all dose ranges (100 to 1000 mcg/d) in FEV1 (between 0.1 to 0.43 litres); morning PEF (between 23 and 46 l/min); symptom scores (based on a standardised scale, between 0.44 and 0.7); reduction in rescue beta-2 agonist use (between 1 and 1.4 puffs/day). High dose FP reduced the number of patients dependent on prednisolone: FP 1000-1500 µg/d Peto Odds Ratio 14.07 (95% CI 7.17 to 27.57). FP at all doses led to greater likelihood of sore throat, hoarseness and oral candidiasis.

Another Cochrane review 2 (abstract , review [Abstract]) included 51 studies (representing 55 group comparisons) with a total of 10 797 participants. Methodological quality was high. In asthmatics with mild to moderate disease who were not on oral steroids, FP did not exhibit a dose-response effect in the lower dose comparisons in FEV1 (50 µg, 100 µg, 200 µg and 4-500 µg daily). There were no statisitically significant differences between 4-500 µg and 800-1000 µg, and between 50-100 and 800-1000 µg of FP. When 200 µg was compared with 800-1000 µg daily FEV1 favoured the four/five fold increase. For PEF, a dose response was present with FP when low and moderate, and low and high doses of FP were compared. There was no dose-response effect on symptoms or rescue beta-2 agonist use. The likelihood of hoarseness and oral candidiasis was significantly greater for the higher doses (800 to 1000 µg/day). People with oral steroid-dependent asthma treated with FP (2000 µg/day) were significantly more likely to reduce oral prednisolone than those on 1000 to 1500 µg/day (OR 2.8, 95% CI 1.3 to 6.3). The highest dose also allowed a significant reduction in daily oral prednisolone dose compared to 1000 to 1500 µg/day (WMD 2.0 mg/day, 95% CI 0.1 to 4.0 mg/day).

    References

    • Adams NP, Bestall JC, Lasserson TJ, Jones P, Cates CJ. Fluticasone versus placebo for chronic asthma in adults and children. Cochrane Database Syst Rev. 2008;(4):CD003135. [PubMed]
    • Adams NP, Bestall JC, Jones P, Lasserson TJ, Griffiths B, Cates CJ. Fluticasone at different doses for chronic asthma in adults and children. Cochrane Database Syst Rev 2008;(4):CD003534. [PubMed]

Primary/Secondary Keywords