FCAAIA NOTES:  Inhaled corticosteroids (ICS) are the preventive treatment of choice for persistent asthma. Over the years, there have been numerous studies showing that higher doses do not necessarily work better than lower doses.  Those studies recommend adding a second preventive medication if asthma control is inadequate on the lower dose of ICS. One caveat, however: In any study looking at a group of people, the results might not apply to every individual within the group. For instance, some people might do better with a higher ICS dose and others will not.  Some patients improve with a leukotriene modifier medication (e.g., Singulair or Zyflo), while others do not.  Every time your medical regimen is changed, you must ask yourself if it helped.  If not, follow-up with your allergist for other recommendations.

(Source:   May 8, 2012)

Background: While most of the clinical benefits of inhaled corticosteroid (ICS) therapy may occur at low doses, results of dose-ranging studies are inconsistent. Although symptom/lung function response to low and high dose ICS medication is comparable, it is uncertain whether low dose ICSs are as effective as high dose in the treatment of inflammation and remodeling.
Methods: 22 mild or moderate asthmatic adult subjects (corticosteroid free for > 2 months) participated in a randomized, parallel group study to compare effects of fluticasone propionate (FP) 200 mcg/day and 1000 mcg/day. Alveolar macrophage (AM)-derived cytokines and basement membrane thickness (BMT) were measured at baseline and after 7 weeks treatment while symptoms, spirometry, exhaled nitric oxide (eNO) and airway hyperresponsiveness (AHR) to mannitol at baseline and 6 weeks.
Results: FP improved spirometry, eNO, symptoms and AHR with no difference between low and high dose FP. Both high and low dose FP reduced GM-CSF, TNF-alpha and IL-1ra, with no change in BMT and with no differences between low and high dose FP.
Conclusions: 200 μg/day of FP was as effective as 1000 μg/day in improving asthma control, airway inflammation, lung function and AHR in adults in the short term. Future studies should examine potential differential effects between low and high dose combination therapy (ICS/long acting beta agonist) on inflammation and airway remodeling over longer treatment periods.


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