Recommended dose range of fluticasone for asthma should be reduced

The therapeutic dose range of fluticasone propionate for asthma in adolescents and adults should be revised downwards from the currently recommended 200-2000 µg/day. Holt et al's meta-analysis (p 253) of randomised controlled trials, which included over 2300 adults and adolescents with moderate to severe asthma, shows that most of the efficacy of fluticasone is achieved at a dose of 100-250 µg/day, with a maximum effect at around 500 µg/day. These findings applied to all clinical outcomes, including exacerbations. The study also partially explains why adding a long acting  agonist is more efficacious than increasing the dose of fluticasone beyond 500 µg/day.

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Relevant Article

Dose-response relation of inhaled fluticasone propionate in adolescents and adults with asthma: meta-analysis • Commentary: Dosage needs systematic and critical review

Shaun Holt, Aneta Suder, Mark Weatherall, Soo Cheng, Philippa Shirtcliffe, Richard Beasley, and Andrew Herxheimer
BMJ 2001 323: 253. [Abstract] [Full Text] [PDF]