INHALED FLUTICASONE PROPIONATE IN THE TREATMENT OF ASTHMA

Inhaled anti-inflammatory agents are currently accepted treatments for asthma; the most effective of these are the inhaled corticosteroids. Fluticasone propionate, recently approved in the United States, is ind icated for prophylaxis and maintenance therapy and for patients who no rmally require oral corticosteroids. Three dosage strengths, 44, 110, and 220 mu g, of two to four puffs twice daily, are available. Recomme nded dosage depends on previous therapy and response to fluticasone. F luticasone propionate has been evaluated in numerous clinical comparis ons with placebo, beclomethasone dipropionate (BDP), budesonide (BUD), nedocromil, and sodium cromoglycate. Short-term trials generally conf irm that fluticasone propionate has about twice the antiinflammatory p otency of BDP in adults, with little difference in efficacy or tolerab ility. Long-term trials in adults indicated that fluticasone propionat e 500 to 1500 mu g/d exhibited comparable efficacy to BDP 1000 to 1500 mu g/d; both drugs were well tolerated. In children and adolescents, fluticasone propionate was found to be significantly superior to place bo and sodium cromoglycate and as effective as BDP. Although early cli nical results suggested that its low oral bioavailability might mitiga te systemic safety concerns, recent evidence has raised new safety iss ues, especially in young children. In particular, the current formulat ion of inhaled fluticasone propionate may have the potential to cause significantly greater suppression of the hypothalamic-pituitary-adrena l (HPA) axis than that used in the early trials. Further study of long -term effects on HPA-axis suppression and growth inhibition is needed.