used for several decades now for the management of asthma patients. They relax
the bronchi and provide immediate relief to an asthmatic struggling for breath.
The inhalers provided local relief of symptoms without side effects to other
parts of the body.
‘Taking a combination of fluticasone with salmeterol results in fewer asthma exacerbations as compared to fluticasone alone in patients with moderate -to-severe asthma.’
A short duration
of action of the older beta agonists necessitated frequent doses. To overcome
this, long-acting beta blockers like salmeterol
were brought into the market. Addition
of corticosteroids ensured additional relief from inflammation.
Nationwide Surveillance (SNS) trial and the Salmeterol Multicenter Asthma
Research Trial (SMART) found that regular use of salmeterol was associated with
higher risk of asthma-related deaths as compared to salbutamol or placebo,
respectively. A further study suggested that these deaths could be reduced when
salmeterol was administered with a corticosteroid, fluticasone propionate.
published in the New England Journal of
compared the use of a fixed dose combination of fluticasone and
salmeterol with fluticasone alone in patients with moderate-to-severe asthma of
at least a year's duration and requiring daily treatment. The patients had an
exacerbation of asthma in the previous year. The study was conducted in 33
countries and treatment of either fluticasone alone or in combination with
salmeterol was administered for a duration of 26 weeks.
noted the following:
- Serious asthma-related events were
similar in the two groups (36 events in the fluticasone-salmeterol group and 38
in the fluticasone-only group).
- The risk of a severe asthma
exacerbation was lower with the fluticasone-salmeterol group as compared to the
- No asthma-related deaths occurred in
- No age or racial group was found to require
more frequent hospitalization due to asthma.
percentages of withdrawal from treatments due to side effects were similar in
both the groups (3%).
combination of fluticasone and salmeterol may be preferable to either drug used
alone in the treatment of moderate-to-severe asthma.
DA et al for the AUSTRI
investigators. Serious Asthma Events with Fluticasone plus Salmeterol versus
Fluticasone Alone. N Engl J Med. DOI: 10.1056/NEJMoa1511049