www.7plus7.com

 

Add-On Therapy Better than Increased Doses for Corticosteroid Treatment in Asthma Patients
A DGReview of :"Effects of Varying Doses of Fluticasone Propionate on the Physiology and Bronchial Wall Immunopathology in Mild-to-Moderate Asthma."

Add-on therapy should be preferred to increased doses of inhaled corticosteroids in asthma patients who do not respond to inhaled corticosteroid monotherapy.Researchers at the Royal Free and University College Hospital Medical School, in London, England, assessed the effects of varied doses of fluticasone propionate among patients with mild to moderate asthma.Inhaled corticosteroids (ICS) are normally associated with a flat dose-response curve in asthma patients when traditional efficacy values such as FEV1 are assessed, the researchers note. In their study they investigated whether a dose-response relationship exists for lung function and inflammatory cell numbers in bronchial biopsy specimens.

They obtained bronchial biopsy specimens from 36 patients who were randomised to receive fluticasone propionate (FP) at doses of 100 mcg, 500 mcg, or 2,000 mcg per day. Lung physiology tests and bronchial biopsies were performed at baseline and at two weeks.Optimal improvement in lung function and suppression of airway inflammation was observed with 500 mcg.Significant changes from baseline at this dose were documented in FEV1 (p=0.02), forced expiratory flow (p=0.002), FEV1/forced volume capacity (p=0.007), provocative concentration of histamine causing a 20 percent fall in FEV1 (PC20) (p=0.02), T-cell numbers(p=0.0005), activated eosinophils (p=0.01), and numbers of macrophages (p=0.01).The researchers did not see a dose-response relationship for change from baseline in PC20 (p=0.43), any of the lung function parameters, T-cell numbers (p=0.64), activated T cells (p=0.46), eosinophils (p=0.53), activated eosinophils (p=0.48), or macrophage numbers (p=0.68)."The apparent lack of a dose-response for ICS treatment in patients with asthma further validates the preferential use of add-on therapy over increasing the dose of ICS," the authors conclude.