Jr3 Asthma

7/30/2019 Jr3 Asthma

1/13

Presented by:

dr.Ahmad Aswar Siregar

Supervisor :

dr.Amira P Tarigan Sp.P

Journal reading 3

Comparative study of long acting -2 agonist and low dose inhaled

corticosteroid combination versus medium dose inhaled corticosteroid

in therapy of moderate persistent asthma


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Asthma

chronic inflammatory

disorder of the airways in

which many cells and cellular

elements play a role

airway hyper-responsiveness that

leads to recurrent episodes ofwheezing, breathlessness, chest

tightness, and coughing, particularly

at night or in the early morning

INTRODUCTION

airflow obstruction within the lung

that is often reversible either

spontaneously or with treatment


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MATERIAL AND

METHODS

Included criteria

Diagnosed cases of moderate persistent asthma

Visiting out patient Department of Tuberculosis and Respiratory

Diseases and Department of Postgraduate Medicine,

S.N.Medical College, Agra

Aged over 14 years


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MATERIAL AND

METHODS Excluded criteria

Smokers either active or passive

history of exposure to occupational sensitizer

History of lower respiratory tract infection within one month

Pregnancy

Patients with known case of chronic obstructive pulmonary disease

Cardiac illness

Hypertension


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Included- daily symptoms, exacerbation thatmay affect activity and sleep, nocturnal symptoms

more than once a week, FEV1 or PEF 60-80%

predicted and FEV1 or PEF variability >30%.

MATERIAL AND

METHODS

Methodology to diagnose moderate persistent asthma


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salmeterol 25g + fluticasone propionate 125 g

formoterol 6 g + budesonide 200 g

fluticasone propionate 250 g and budesonide 400 g

.

MATERIAL AND

METHODSStudy Design

Jan 5th 2007 - Des31st 2007 randomized control trial

Baseline values were recorded about symptoms, FEV1, PEF through spirometry

The drugs were administered through metered dose inhaler with spacer.All rescue

medications were replaced by inhaled levosalbutamol during exacerbations

The patients were followed up weekly for12 weeks. At the end of 12 weeks, spirometry

was performed again on each patient and results were compared with base line values

During

59 casestreatment

twice daily


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Out of total 69 cases 59 patients followed the strict protocol.

Only the results of 59 cases were analyzed.

Statistically significant (p value < 0.01) increase in FEV1 was

recorded at the end of 12 weeks in each group compared tobaseline values.

RESULTS

No significant difference was found in FEV1 values at 12thweek (p value>0.05) among these four treatment groups.

No significant difference (p value > 0.05) was found in the

number of exacerbations in any of two treatment groups ,

in 12 week study period.


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CONCLUSION

The results of present study suggest that combination therapy

(salmeterol+fluticasone , formoterol+ budesonide)is slightly more efficacious and the control is rapid than medium dose

ICS (fluticasone, budesonide)in treatment of moderate persistent asthma.

Patients of moderate persistent asthma should be treated by

combination of ICS+LABAinitially and maintenance therapy may be

higher dose of ICS

to avoid worsening of asthma associated with

long term use of LABA.Whereas patients on high risk of

developing ICS induced side effects(old age, immunocompromised state, AIDS etc.) should be treated with

combination therapy of LABA and ICS


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ThankYouBujur

Syukran


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The present study compared the effects of treatment with a combination of low dose

ICS with LABA against medium dose ICS in asthma. The results are based on a small

exploratory study and should be considered as hypothesis generating rather thandefinitive.

DISCUSSION

Statistically significantly increases in FEV 1 at the end of 12 weeks in each treatment

group was recorded compared to baseline values but no significant difference wasfound in FEV1 values at 12th week among these four groups. There was no significant

difference in any of the two treatment groups in number of exacerbations. However,

number of exacerbations were less in combination therapy


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DISCUSSION

Apart from this, patients receiving combination therapy respond sooner thanICS alone. Our findings are similar to VanNoord et al,11 who used salmeterol

50mcg and fluticasone propionate 250mcg against 500mcg fluticasone

propionate twice daily. They found that increase in FEV1 was higher in

combination group than fluticasone alone group at the end of 4 weeks but not

after 12 weeks. The salmeterol group also showed lesser the need for rescue

medication. Similar findings were also observed by Matz et al12. Kips andPauwels13 got similar results in budesonide and formoterol combination Vs

increased dose of budesonide alone.

Condemi et al14 and Pearlman.15 found the combination therapy of

fluticasone 88mcg and salmeterol 42 mcg significantly better than fluticasone220mcg alone in terms of FEV1%, PEFR and use ofrescue medicine. Kelsen

al16 observed similar finding with salmeterol 42mcg+ beclomethasone 168

mcg versus beclomethasone 336mcg. The difference observed in various

studies may be due to difference in patient selection criteria like -level of

asthma (mild persistent /moderate persistent/ severe) and difference in drugs

doses and mode of drug delivery.

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