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Fluticasone

Fluticasone proprionate is a glucocorticoid often prescribed as treatment for asthma and allergic rhinitis. It is marketed with the brand name Flixotide® and Flixonase® by Allen & Hanburys and Flovent® and Flonase® by GlaxoSmithKline. more...

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How it works

The precise mechanisms of glucocorticoid action in asthma are unknown. Inflammation is recognized as an important component in the pathogenesis of asthma. Glucocorticoids have been shown to inhibit multiple cell types (e.g., mast cells, eosinophils, basophils, lymphocytes, macrophages, and neutrophils) and mediator production or secretion (e.g., histamine, eicosanoids, leukotrienes, and cytokines) involved in the asthmatic response. These anti-inflammatory actions of glucocorticoids may contribute to their efficacy in asthma. Typically, however, the action on the cells affected requires several days. Therefore, inhaled steroids are not used for immediate relief of asthma, but instead as preventive and maintenance therapy.

Clinical trials

This listing is NOT complete and should NOT be construed as support for treatment decisions. See also PubMed clinical manuscripts referring to fluticasone

Burge, P.S.; Calverley, P.M.; Jones, P.W.; Spencer, S.; Anderson, J.A.; and Maslen T.K. (2000). Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial. British Medical Journal 320 (7245), 1297-1303. PMID 10807619.
Paggiaro, P.L.; Dahle, R.; Bakran, I.; Frith, L.; Hollingworth, K.; and Efthimiou, J. (1998). Multicentre randomised placebo-controlled trial of inhaled fluticasone propionate in patients with chronic obstructive pulmonary disease. The Lancet 351 (9105), 773-780. PMID 9519948.

both support a positive outcome for use of fluticasone in patients with chronic obstructive pulmonary disease, also referred to as COPD

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Clinical efficacy of aerosolized fluticasone therapy in the early management of acute moderate exacerbations of asthma by PMDI and zero stat 'V' spacer
From CHEST, 10/1/05 by Sudhir K. Agarwal

PURPOSE: To assess the utility of inhaled corticosteroids for the early management of acute exacerbations of asthma in the emergency room.

METHODS: This randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy of high dose inhaled fluticasone with frequent beta-2-agonist therapy in patients of acute moderate exacerbations of asthma. Eighty patients between 15 and 45 years of age with acute moderate exacerbations of asthma were put on aerosolized 500 [micro]g of fluticasone at half hourly intervals for three doses with metered dose inhaler and zero stat "V" spacer. All patients received humidified oxygen and nebulized salbutamol (0.15 mg/kg in 3 ml saline) prior to fluticasone administration. The control group received placebo instead of inhaled fluticasone. Patients who had received corticosteroids in the preceding 72 h were excluded from the study. If there was an inadequate response or no response to treatment at the end of 2 hour, oxygen and salbutamol therapy were continued and given one dose of intravenous hydrocortisone and was started on an aminophylline infusion.

RESULTS: Both fluticasone and control group showed a significant improvement in respiratory status at the end of 2 h. However, patients in the fluticasone group showed greater improvement in PEFR (P < 0.05) and significantly lower proportion of patients required oxygen improvement in PEFR (P < 0.01). The length of stay was significantly shorter in the fluticasone group than in the placebo group (P < 0.01).

CONCLUSION: Aerosolized fluticasone therapy with MDI and spacer together with salbutamol in the treatment of acute exacerbations of asthma helped in early recovery and decreased hospital stay.

CLINICAL IMPLICATIONS: Inhaled fluticasone may be given with MDI and spacer in the treatment of acute exacerbations of asthma.

DISCLOSURE: Sudhir Agarwal, None.

Sudhir K. Agarwal MD * Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

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