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Update in Pulmonary Disease
- Antonio Anzueto, MD; and
- Luis Angel, MD
- From the University of Texas Health Science Center at San Antonio and South Texas Veterans Affairs Health Care System, San Antonio, Texas.
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
In this Update, we review six topics in pulmonary disease that will be relevant to general internists: asthma, chronic obstructive pulmonary disease (COPD), acute exacerbation of chronic bronchitis, community-acquired pneumonia, interstitial disease and idiopathic pulmonary fibrosis, and venous thromboembolic disease.
Asthma
Inhaled corticosteroids have been shown to be potent and effective anti-inflammatory agents for the treatment of persistent asthma. However, these drugs are often underused because of concerns about their safety and the fact that patients often do not perceive immediate symptom relief. The addition of a long-acting bronchodilator to inhaled corticosteroids for the treatment of asthma has been shown to improve pulmonary function and symptoms markedly compared with increasing the dose of inhaled corticosteroids. Several studies have reported the efficacy and safety of salmeterol and fluticasone given as individual agents in the treatment of asthma, in inhaled form or Diskus powder formulation (Glaxo Wellcome, Research Triangle Park, North Carolina).
Combination Therapy May Simplify the Management of Patients with Asthma
Shapiro G, Lumry W, Wolfe J, et al. Combined salmeterol 50 µg and fluticasone propionate 250 µg in the Diskus device for the treatment of asthma. Am J Respir Crit Care Med. 2000;161:527-34.
Shapiro and colleagues conducted a 12-week randomized, double-blind, parallel-group study to compare asthma treatments delivered in dry-powder form through the Diskus device. They compared the efficacy and safety of salmeterol plus fluticasone with the efficacy and safety of fluticasone and salmeterol alone in patients previously treated with low to medium doses of inhaled corticosteroids.
Study participants were required to have an increase in FEV1 of more than 15% at 30 minutes after two puffs of inhaled albuterol, 180 µg, and to have received inhaled corticosteroids continuously for at least 12 weeks before the study. …
