Differential effects of inhaled corticosteroids: Fluticasone propionate versus triamcinolone acetonide

We conducted a double-blind, double-dummy, placebo-controlled trial to directly compare differences in clinical efficacy and effect on quality of life between fluticasone propionate and triamcinolone acetonide. A total of 304 male and female patients with asthma who were previously maintained on beclomethasone dipropionate or triamcinolone were randomly assigned to 24 weeks of treatment with either fluticasone powder 250 mu g twice daily via a breath-actuated inhalation device, triamcinolone aerosol 200 mu g four times daily via metered dose inhaler, or placebo. At endpoint, the mean increase in forced expiratory volume in one second (FEV1) at endpoint was significantly greater in patients treated with fluticasone (0.32L) than in patients treated with triamcinolone (0.03L) or placebo (-0.18L) (P < 0.001). Mean increase in morning peak expiratory flow at endpoint was 18 L/min with fluticasone compared with mean decreases of 3 L/min and 24 L/min in the triamcinolone and placebo groups, respectively (P < 0.001) versus placebo and triamcinolone). After treatment with fluticasone, mean change from baseline to endpoint in supplemental albuterol use, nighttime awakenings, probability of remaining in the study, and Asthma Quality of Life Questionnaire global scores was significantly improved compared with triamcinolone or placebo (P < 0.05). Low morning plasma cortisol concentration measurements were infrequent and similar across treatment groups. Fluticasone powder administered twice daily (500 mu g/day) is more effective than triamcinolone aerosol administered four times daily (800 mu g/day) with respect to number of nighttime awakenings, supplemental albuterol use, probability of remaining in the study, pulmonary function, and quality of life measures without compromising adrenal function in patients with asthma.