Step-Down" Approach May Be Unnecessary


High-dose fluticasone versus low-dose flucticasone is no more effective in treating asthma. A study, reported in Chest (January 2005), found that starting individuals with moderate asthma on a high dose of the inhaled steroid and then stepping down to a low dose provides no greater benefit than starting at a low fixed dose.

For the study, the researchers randomly assigned 35 patients to begin inhaled fluticasone propionate at 1000 mcg per day and then to lower the dose to 200 mcg per day, or to start treatment at a fixed dose of 200 mcg.

The results of the study showed that both regimens lowered bronchial hyperresponsiveness and airway inflammation to a similar degree. Furthermore, 8 weeks after stopping fluticasone, inflammation indicators stayed in the normal range in 30% of the patients in both groups.