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PEDIATRICS Vol. 110 No. 2 August 2002, pp. 463-464

ASTHMA: LEUKOTRIENE ANTAGONIST THERAPY

A Comparison of Short-Term Treatment with Inhaled Fluticasone Propionate and Zafirlukast for Patients with Persistent Asthma

Allen Adinoff, MD

Aurora, CO

Purpose of the Study. To compare the short-term efficacy and safety of low-dose fluticasone propionate with that of oral zafirlukast therapy for patients previously treated with ß₂-agonists alone, and to evaluate the potential therapeutic benefit of switching from zafirlukast to a low-dose inhaled corticosteroid.

Subjects and Methods. This study consisted of a 4-week randomized, double-blind treatment period followed by a 4-week open-label period. Two hundred ninety-four patients 12 years old with asthma previously uncontrolled with ß₂-agonists alone were randomly assigned to treatment with low-dose inhaled fluticasone (88 µg twice daily) or oral zafirlukast (20 mg twice daily). After 4 weeks, all patients discontinued their double-blind therapy and received open-label fluticasone (88 µg twice daily). Outcomes included pulmonary function, asthma symptoms, albuterol use, asthma exacerbations, and adverse events.

Results. During the double-blind treatment period, fluticasone patients had significantly greater improvements in morning peak flow (29.3 L/min vs 18.3 L/min), percentage of symptom-free days (19.8% vs 11.6%), and daily albuterol use ( -1.8 puffs per day vs -1.1 puffs per day) compared with zafirlukast patients (P .025, each comparison). During the open-label treatment period, patients switched from zafirlukast to fluticasone experienced additional improvements in morning peak flow (17.2 L/min), evening peak flow (13.6 L/min), and forced expiratory volume in 1 second (FEV₁) (0.11 liter) and daily albuterol use ( -0.9 puffs daily) compared with values obtained at the end of the double-blind treatment period (P .001, each comparison).

Conclusions. Low-dose fluticasone was more effective than zafirlukast in improving pulmonary function and symptoms in patients with persistent asthma. In addition, switching patients from zafirlukast to fluticasone further improved clinical outcomes.

Reviewer’s Comments. The emerging consensus is that inhaled corticosteroids, in general, are more effective monotherapy for asthma than are leukotriene receptor antagonists, at least in short-term studies. Certainly, however, many individual patients with mild persistent asthma will do very well taking only leukotriene receptor antagonists. In addition, long-term studies may suggest at least similar benefits due to improved compliance with oral medications.

REFERENCES

Nathan RA, Bleecker ER, Kalberg C. Am J Med.2001; 111 :195 –200[CrossRef][Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Adinoff, A. Search for Related Content PubMed Articles by Adinoff, A. Social Bookmarking                         What's this?