Comparative Analysis Of Strategies For Reducing Treatment In Asthma

Objective To compare the efficacy of different strategies for reducing treatment in severe persistent asthma and to explore the optimal strategy.Methods 111 patients with severe persistent asthma were enrolled in the study and randomized into four groups:(ⅰ)group A,(first reduced the dose of fluticasone at 24 weeks intervals);(ⅱ)group B(first reduced the dose of salmeterol at 24 weeks intervals);(ⅲ)group C(first reduced the dose of fluticasone at 12 weeks intervals);and(ⅲⅰ)group D(first reduced the dose of salmeterol at 12 weeks intervals).Each group received salmeterol/fluticasone 50/250ug twice daily for the first 4 weeks and then patients whose conditions were improved continued to receive further treatment.The endpoint of the study was till the dose of fluticasone reduced to 125ug twice daily.Asthma symptoms control,respiratory function,exacerbation rate,and adverse events were monitored.Results 1.After the first 4 weeks,marked improvements in lung function were seen and 101 of 111 patients(＞90%)achieved controlled and partly controlled status.2.No statistically significant difference in lung function and in asthma control was found at any scheduled visit between the groups first reduced the dose of salmeterol and the groups first reduced the dose of fluticasone.3.Exacerbation rate was high in group A(11.7%)and group B(13.6%),but it was low in group C and group D.4.All four strategies for reducing treatment were well tolerated and the most frequently reported adverse event was excessive phlegm.Conclusion 1.Majority of severe persistent asthma patients can be well controlled with salmeterol/fluticasone 50/250ug twice daily.2.The groups first reduced the dose of fluticasone are as effective as the groups first reduced the dose of salmeterol.But the former is more economic.3.There are not different in achieving and maintaining asthma control between the groups each treatment step assigned to maintain for 24 weeks and the groups for 12 weeks.4.In majority of severe persistent asthma whose asthma was well controlled,either the long-acting beta2-agonist or corticosteroid could be reduced without loss of asthma control.