Inhaled fluticasone propionate/salmeterol controls asthma and improves health-related quality of life

Thailand: A review article published in Respiratory Medicine has highlighted that the Health-related quality of life (HRQoL) is the outcome that assesses the impacts of asthma. Fixed dose inhaled fluticasone propionate/salmeterol (FP/Sal) significantly improves HRQoL. The review concluded that HRQoL is well-manageable with regular FP/Sal in moderate-to-severe asthma.

Despite the availability of therapeutic options, many patients have uncontrolled asthma. This may be due to under-perception of symptoms, a lack of adherence to asthma treatment, comorbidities, inadequate treatment, etc. Patients with uncontrolled asthma are at higher risk of experiencing exacerbations, loss of lung function, and impaired quality of life and functional abilities.

Treatment efficacy is determined by lung function as a primary endpoint. Uncontrolled asthma impacts daily lives, and hence based on outcomes reported by patients, various endpoints and assessment measures have been established like Asthma Control Questionnaire, Asthma Control Test, health-related quality of life (HRQoL), the Asthma Quality of Life Questionnaire (AQLQ). Etc.

The literature mentions studies assessing the HRQoL burden in asthmatic patients, but only a few mention the comparative asthmatic treatment effects on improvements in HRQoL. There is an association between better asthma control and improved HRQoL in adults with asthma. Furthermore, FP/Sal treatment has been related to asthma control and reduced severity of asthmatic exacerbations, thereby improving AQLQ scores.

Considering this, a study was conducted by a team of researchers led by Dr. Maneechotesuwan from the Division of Respiratory Diseases and Tuberculosis at the Department of Medicine at Mahedol University to evaluate the relative efficacy of FP/Sal versus other inhaled treatment regimens. The study also mentioned the relationship between changes in asthma control and HRQoL.

The key points of the study are:

• The Asthma Quality of Life Questionnaire (AQLQ) in patients with moderate-to-severe asthma was reviewed.
• Random effects Bayesian NMAs derived estimates of the mean difference in CFB in AQLQ vs. other interventions.
• The impact related to follow-up, asthma control on baseline, observational studies inclusion, adjusting baseline FEV1, and low-medium ICS dose arms were included in a sensitivity analysis.
• Linear regression analysis compared CFBs in AQLQ and ACQ scores.
• Mean CFB demonstrated expected ranked effects in AQLQ with FP/Sal vs. comparators. The mean difference was 0.65 versus placebo, 0.58 versus LABA, 0.21 versus ICS alone, 0.06 versus other ICS/LABA, and 0.00 versus ICS/formoterol MART.
• The consistency in results was mainly shown in sensitivity analyses.
• A strong correlation was between AQLQ and ACQ with a P value of 0.94.
• Improved asthma control was strongly associated with improvement in AQLQ, as shown by linear regression analysis.

The present study highlighted the benefits of regular treatment with FP/Sal, which aids in achieving clinically relevant improvements in HRQoL in adult patients with a history of moderate-to-severe asthma.

They said we found that The improvements reported in the study are significantly more significant than placebo or ICS monotherapy. The worsening of asthmatic control badly affects the patient's quality of life.

Our study adds to the previous findings reported by Bateman et al. on HRQoL by comparing the effects of a specific ICS/LABA, FP/Sal, with other inhaled ICS and ICS/LABA treatment regimens they wrote.

As demonstrated by the GOAL study, more than 70% of patients on regular FP/Sal could achieve and maintain well-controlled asthma. The researchers wrote that our network meta-analysis showed that fixed-dose, twice-daily FP/Sal significantly improves HRQoL in moderate to severe asthmatic patients. Our study confirms how vital HRQoL is as an outcome and is responsive to treatment, which explains its strong association with asthma control.

The analysis had limitations like lack of evidence of stratified or subgroup results, inconsistency, and lack of reporting for comorbidities, etc.

Further reading:

Impact of inhaled fluticasone propionate/salmeterol on health-related quality of life in asthma: A network meta-analysis