Addition of salmeterol versus doubling the dose of fluticasone propionate in patients with mild to moderate asthma

Background-The objective of this multicentre, randomised, double blind, parallel group study was to compare the efficacy and safety of the addition of salmeterol with that of doubling the dose of fluticasone propionate in asthmatic patients not controlled by a low or intermediate dose of inhaled corticosteroids. Methods-After a four week run in period of treatment with fluticasone propionate (100 mu g twice daily if pre-trial dose was 400-600 mu g inhaled corticosteroids or 250 mu g twice daily if pre-trial dose was 800-1200 mu g inhaled corticosteroids), 274 patients were randomised to treatment for 12 weeks with either salmeterol 50 mu g twice daily plus the run in dose of fluticasone propionate or twice the run in dose of fluticasone propionate (200 or 500 mu g twice daily). Outcome measures were daily records of peak expiratory flow (PEF), symptom scores, and clinic lung function. Results-The improvements in both the morning and evening PEF were better in the salmeterol than in the fluticasone propionate group, the mean increase in morning PEF being 19 l/min higher (95% CI 11.0 to 26.1) and in evening PEF being 16 l/min (95% CI 18.4 to 24.0) higher in the salmeterol group. The increase in forced expiratory volume in one second (FEV,) was 0.09 1 greater in the salmeterol group than in the fluticasone propionate group after four weeks of treatment (95% CI 0.01 to 0.18), but not after 12 weeks. Both regimens showed an increase in symptom free low or days and a reduction in the need for steroids. rescue salbutamol both during the day and the night, but these improvements were greater in the salmeterol group. There were no significant differences between the groups in adverse effects or in the number of rescue courses of oral corticosteroids. Conclusions-In this group of patients still symptomatic despite 100 or 250 mu g fluticasone propionate twice daily, the addition of salmeterol caused a greater improvement in lung function and symptom control than doubling the dose of fluticasone propionate.