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Benefits of low-dose inhaled fluticasone on airway response and inflammation in mild asthma.

Author(s): Boulet LP, Turcotte H, Prince P, Lemiere C, Olivenstein R, Laprise C, Larivee P, Begin P, Laviolette M

Affiliation(s): Unite de recherche en pneumologie, Institut universitaire de cardiologie et de pneumologie de Quebec, 2725 Chemin Sainte-Foy, Quebec8, PQ, Canada G1V 4G5. lpboulet@med.ulaval.ca

Publication date & source: 2009-10, Respir Med., 103(10):1554-63. Epub 2009 Aug 18.

Publication type: Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

RATIONALE: Current guidelines suggest that asthma should be controlled with the lowest dose of maintenance medication required. OBJECTIVES: To evaluate the effects of a low dose of inhaled corticosteroid compared to a placebo, on airway inflammation and responsiveness in patients with mild symptomatic asthma. METHODS: In this randomized double-blind, placebo-controlled, parallel group study, we looked at the influence of inhaled fluticasone propionate 250 microg/day for 3 months followed by 100 microg/day for 9 months on airway inflammation and methacholine responsiveness in non-smoking subjects with mild allergic asthma. Subjects were evaluated at baseline and 3, 6, 9 and 12 months after treatments; a 2-week evaluation of respiratory symptoms and peak expiratory flow measurements was done before each visit. RESULTS: Fifty-seven subjects completed the 3-month study period. Airway responsiveness, expressed as the PC20 methacholine, increased by 0.27 and 1.14 doubling concentrations, respectively, in placebo-treated (n=33) and in fluticasone-treated (n=24) asthmatic subjects (p=0.03). An additional improvement in PC20 up to 2.16 doubling concentrations was observed in the fluticasone-treated group during the 9-month lower-dose treatment (p=0.0004, end of low-dose period compared with placebo). Sputum eosinophil counts decreased after 3 months of fluticasone 250 microg/day compared with placebo (p<0.0001) and remained in the normal range during the 9-month lower-dose treatment. Respiratory symptoms and peak expiratory flows did not change significantly throughout the study in both groups. CONCLUSION: In mild asthma, keeping a regular minimal dose of ICS after asthma control has been achieved, may lead to a further reduction in airway responsiveness and keep sputum eosinophil count within the normal range.

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