Inhaled Salmeterol/Fluticasone Propionate Combination in Chronic Obstructive Pulmonary Disease
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Am J Respir Med 2002; 1 (4): 283-284 1175-6365/02/0004-0283/$25.00/0 © Adis International Limited. All rights reserved.
Inhaled Salmeterol/Fluticasone Propionate Combination in Chronic Obstructive Pulmonary Disease A Viewpoint by Wilfried De Backer Department of Pulmonary Disease, University of Antwerp, Antwerp, Belgium
Chronic obstructive pulmonary disease (COPD), currently the fourth leading cause of death in the US, will probably be the third leading cause of death by 2020. The economic and social burden of the disease is considerable and, in 2020, COPD will be the fifth leading cause of disability-adjusted life years (behind ischemic heart disease, major depression, traffic accidents and cerebrovascular disease). Therefore, preventive measures and therapeutic interventions that can inhibit disease progression or diminish its impact on the quality of life are needed. The currently available pharmacological agents cannot modify the long-term decline in forced expiratory volume in 1 second (FEV1), but some can control symptoms and reduce the frequency and severity of exacerbations. In patients with COPD, the long-acting β2-adrenoceptor agonist salmeterol 50μg inhaled twice daily improves health status[1] and induces a constant bronchodilatory effect without evidence of tolerance.[2] Inhaled fluticasone propionate 500μg twice daily only slightly improves FEV1, but decreases the number of exacerbations and significantly slows down the decline in health status.[3] Because the two drugs act differently, their combined use in a single formulation could provide additive effects. The accompanying article summarizes two major studies that confirm the beneficial effects of salmeterol/fluticasone propionate in a fixed-dose combination in patients with COPD. Both studies, which used either high (500μg) or low (250μg) dosages of fluticasone propionate twice daily, showed that combined salmeterol/ fluticasone propionate preparations significantly improved FEV1 compared with placebo, fluticasone propionate or salmeterol given as single agents. In comparison with fluticasone propionate monotherapy or placebo, health status significantly improved only with salmeterol/fluticasone propionate 50/500μg and not with salmeterol/fluticasone propionate 50/250μg. In a recently presented third study evaluating 1465 patients with moderate to severe COPD and a mean FEV1 of 45%,[4] salmeterol/ fluticasone propionate 50/500μg produced greater improvements in lung function, number of exacerbations and symptoms compared with placebo, or salmeterol or fluticasone propionate as single agents, without compromising the tolerability profile. Evidence is accumulating that the salmeterol/fluticasone propionate combination, particularly the 50/500μg dosage, can improve
quality of life, diminish exacerbation rates and improve pre- and post-bronchodilator FEV1. However, some limitations of these studies should be mentioned. All studies have included patients with moderate to severe COPD and, therefore, the positioning of salmeterol/fluticasone propiona
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