Date - 17 June 2005

Sources- Drugs in Context 2005; 1(5): Seretide® - Asthma p235

Author - Dr Anna Palmer

Fluticasone propionate (hereafter referred to as fluticasone) is a potent inhaled corticosteroid indicated for the maintenance treatment of asthma. Fluticasone appears to be effective at much lower doses than other commonly used inhaled corticosteroids and has the advantage of a low oral bioavailability. Fluticasone, administered at doses as low as 100 µg twice daily, has been shown to improve peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1) and also reduces symptom scores, use of rescue bronchodilator therapy and the incidence of disturbed nights, in both children (aged 4-11 years) and adults. Fluticasone appears to be more effective when it is administered in a twice-daily, rather than a once-daily regimen. Improvements in lung function, after twice-daily fluticasone, are observed rapidly and as early as the first day after initiation of treatment although maximal benefits are not observed until at least two weeks of treatment. The maximum recommended dose of fluticasone (1000 µg/day, twice daily) is also effective in improving lung function in patients with more severe asthma. Fluticasone is available for administration via a dry powder inhaler (DPI) or when formulated with aerosols for delivery by a metered dose inhaler (MDI). Both formulations are equally effective and well tolerated. Comparative studies have demonstrated that fluticasone has enhanced efficacy in improving lung function than older inhaled corticosteroids such as beclometasone dipropionate (hereafter referred to as beclometasone) and budesonide. Fluticasone is also more effective than the oral agents, theophylline, montelukast and zafirlukast in the treatment of mild-to-moderate asthma. Treatment with fluticasone is generally well tolerated and at low doses (<200 µg/day in children or <800 µg/day in adults) is rarely associated with clinically significant effects upon adrenal function, bone mineral density or linear growth rates in children.

Keywords: Asthma; fluticasone; salmeterol; Seretide^®; combination