The goal of
asthma treatment has moved from achieving symptom relief alone to overall disease control. The latest guidelines propose that first-line treatment of mild persistent
asthma requires the introduction of
anti-inflammatory agents, preferably inhaled
corticosteroids at low dose. In patients in whom control of disease is not achieved with this treatment, it was demonstrated that addition of a long-acting beta 2-agonist is more effective than increasing the dose of inhaled
corticosteroid. Addition of a long-acting beta 2-agonist to an inhaled
corticosteroid not only improves symptoms and lung function but also reduces the risk of
asthma exacerbations, suggesting complementary therapeutic activity. Therefore, use of long-acting
bronchodilators with inhaled
corticosteroids is a prerequisite for optimal management of the disease. For this reason, the logical development in
asthma management would be a combination of these two classes of
drug in a single inhaled formulation. Fixed combinations of the long-acting beta 2-agonist
salmeterol and the inhaled
corticosteroid fluticasone propionate were launched recently. Results from recent clinical trials have demonstrated that the combination of
salmeterol and
fluticasone propionate improves control of
asthma in the majority of patients with moderate-to-severe
asthma and enhances compliance by virtue of both drugs being in the one
inhaler. The possibility to treat
asthma of differing severity is provided by the flexibility to choose between three different doses of
fluticasone propionate in the fixed combination devices. Another obvious advantage of the combination is cost savings, as the fixed combination
inhaler is cheaper than giving the two drugs separately. The introduction of combination preparations is an important step forward in
asthma management, which is expected to be a popular choice with both patients and physicians.