A COMPARISON OF FLUTICASONE PROPIONATE, 1-MG DAILY, WITH BECLOMETHASONE DIPROPIONATE, 2-MG DAILY, IN THE TREATMENT OF SEVERE ASTHMA

We wanted to compare the efficacy and safety of fluticasone propionate, a new topically active inhaled corticosteroid, to that of high dose beclomethasone dipropionate, in severe adult asthma. Patients currently receiving between 1.5-2.0 mg.day-1 of an inhaled corticosteroid were treated for six weeks in a double-blind, randomized, parallel group study with 1 mg.day-1 fluticasone propionate (n=82), or 2 mg.day-1 beclomethasone dipropionate (n=72). Mean morning peak expiratory flow rates (PEFR) increased from 303 to 321 l.min-1 with fluticasone propionate, and from 294 to 319 1.min-1 with beclomethasone dipropionate. There was an increase in evening PEFR, asthma symptoms improved, and rescue beta2-agonist use decreased for both treatment groups. None of these differences between treatments were statistically significant However, diurnal variation was significantly reduced with fluticasone propionate, when compared with beclomethasone dipropionate (difference = 7 l.min-1; p=0.038). Clinic lung function also improved with both treatments and, apart from % predicted PEFR, which showed no difference after beclomethasone dipropionate but increased from 73 to 78 % with fluticasone propionate, there were no differences between treatments. Forced expiratory volume in one second (FEV1) increased with both treatments. The geometric mean plasma cortisol concentration rose after treatment with fluticasone propionate (from 293 to 309 nmol.l-1) and fell after beclomethasone dipropionate (from 256 to 224 nmol.l-1); the difference between treatments was significant. The incidence of adverse events was low in both treatment groups. In conclusion, 1 mg-day-1 fluticasone propionate was as effective as 2 mg-day-1 beclomethasone dipropionate in the control of severe asthma. However, adrenal function was affected less by fluticasone propionate, which gives it a better overall safety profile. This study, therefore, demonstrates the increased therapeutic potential of fluticasone propionate over beclomethasone dipropionate in severe asthma