Source: Annual Congress 2002 - Asthma - Therapy and management -2
Disease area: Airway diseases

Abstract

Bronchial asthma is an inflammatory disease in which the therapeutic role of inhaled β2-adrenergics and steroids is established: usually they are sequentially administered, β2 preceedings steroids. Aim was to assess the effect of changing the sequence of β2 and steroid inhalation in moderate persistent asthma. Methods – After informed consent, 12 symtomatic subjects (7m.; 18-64y, mean basal FEV1 = 68.6% pred. ±] 11.8sd; reversibility = + 14.9% bsln ±] 8.1sd after Salbutamol 200μg) using FP250μg bid and β2 short-acting prn for over 6wks (baseline), assumed combined SM/FP 50/250μg bid via a single Diskus ®for 6wks. Afterwards, they received SM and FP at the same doses for two further 4-wk periods, via two separate Diskus®. The sequence of SM and FP inhalation changed according to a double-blind, randomized, cross-over design in these periods (SM and after FP for the first period; FP and after SM for the second period, 15' interval between the two drugs). FEV1; PEF; daily b2 prn; nocturnal awakenings, diurnal symptom score were considered. Statistics: Anova (Duncan test), p<0.05 accepted (* p< 0.01 vs bsln). Conclusions: SM and FP dry powder associated or combined affected equally lung function and clinical outcomes. The different sequence of drugs inhalation did not affect both the efficacy and the effectiveness of asthma treatment.

Results	Baseline	Comb. SM/FP	SM and FP	FP and SM
FEV1	68.6±]11.8	79.8±]20.1[degree]	80.7±]19.5[degree]	80.3±]17.4[degree]
PEF	282±]64.1	333±]55.4[degree]	336±]55.4[degree]	338±]67.1[degree]
β2 use prn	4.4±]7.3	1.2±]0.9[degree]	0.9±]0.6[degree]	0.9±]0.8[degree]
Noct.Aw.	1.6±]0.2	0.2±]0.3[degree]	0.3±]0.3[degree]	0.2±]0.3[degree]
Diur.sym.sc.	3.4±]0.8	1.9±]0.7[degree]	1.7±]0.5[degree]	1.8±]0.6[degree]

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Citations should be made in the following way:
R. W. Dal Negro, C. Micheletto, S. Tognella, F. Trevisan, C. Pomari (Bussolengo, Italy). Is the sequence of salmeterol (SM) and fluticasone p. (FP) dry powder inhalation crucial in persistent mild asthma?. Eur Respir J 2002; 20: Suppl. 38, 396

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