Abstract: Slide Presentations |

Effect of Switching from High-dose Inhaled Corticosteroids (ICS) to Low-dose ICS plus an Inhaled Long-acting β2-agonist on Airway Inflammatory Cells and Mediators and Airway Remodeling FREE TO VIEW

Paul M. Dorinsky, MD; Steve Y. Yancey, MS; Patti Rouse, BS; Amanda Emmett, MS; Homer Boushey, MD
Author and Funding Information

Affiliations: @University of California, San Francisco, CA.,  *GlaxoSmithKline, Research Triangle Park, NC

Affiliations: @University of California, San Francisco, CA.,  *GlaxoSmithKline, Research Triangle Park, NC


Chest. 2003;124(4_MeetingAbstracts):86S-b-87S. doi:10.1378/chest.124.4_MeetingAbstracts.86S-b
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PURPOSE:  A 12-week, open-label study designed to examine whether switching to fluticasone propionate/salmeterol (FSC) 100/50mcg maintained control of airway inflammation in asthma patients previously treated with fluticasone propionate (FP) 220mcg BID or an equivalent dose of another inhaled corticosteroid (ICS).

METHODS:  52 patients (mean age 36.8 yrs) on moderate dose ICS (mean dose=498mcg/day) for ≥4 weeks participated. All patients underwent bronchoalveolar lavage (BAL) and biopsy before and 12-weeks after switching to FSC 100/50mcg BID. Eosinophil percentages and inflammatory mediators (GM-CSF, IL-8, ECP, tryptase) were evaluated on BAL specimens. Eosinophils and basement membrane thickness were quantified from biopsy specimens.

RESULTS:  Cell/MediatornBaseline on ICS (mean ± SE)Endpoint on FSC (mean ± SE)p Value*Bronchial mucosa eosinophils (cells/mm3)392715.5 ± 3593173.2 ± 7100.753BAL eosinophils (%)480.52 ± 0.140.84 ± 0.330.522Basement membrane thickness (microns)464.07 ± 0.163.97 ± 0.150.403GM-CSF (pg/mL)311.20 ± 0.182.40 ± 0.670.096IL-8 (pg/mL)3625.54 ± 5.0731.13 ± 7.370.370ECP (μg/mL)360.66 ± 0.252.45 ± 2.060.590Tryptase (μg/mL)460.15 ± 0.070.22 ± 0.090.438*

based upon Wilcoxon signed-rank tests

The switch to FSC was not associated with changes in BAL eosinophils, BAL inflammatory mediators or sub-epithelial collagen thickness on mucosal biopsies. In addition, the switch to FSC was associated with significant (p≤0.05) improvements in AM PEF, rescue albuterol use and asthma symptoms while FEV1 and PC20 were unchanged from baseline.

CONCLUSION:  In patients receiving moderate doses of ICS, FSC 100/50mcg BID enabled a >50% reduction in ICS dose without altering sub-epithelial collagen thickness, eosinophil numbers in BAL or mucosal biopsies, or BAL inflammatory mediators.

CLINICAL IMPLICATIONS:  Treatment with a low dose ICS and a long-acting beta-agonist appears as effective as higher dose ICS alone in controlling eosinophilic airway inflammation.

DISCLOSURE:  P.M. Dorinsky, Employee of GSK, Industry.

Monday, October 27, 2003

2:30 PM - 4:00 PM




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