Abstract
Aims:
The salmeterol/fluticasone combination inhaler (Seretide) has been shown to be effective in the management of asthma by randomised controlled trials. This study examined whether it was also effective in clinical use in primary care.
Methods:
Patients attending the surgery asthma clinic with persistent symptoms despite regular inhaled corticosteroid therapy were offered Seretide. Outcome measures were symptom scores, peak flow measurements, prescriptions for relief bronchodilators, mean daily inhaled steroid dosage, and asthma treatment costs. Patients were assessed at baseline, 9 and 19 months, comparing Seretide users with other asthma clinic attenders.
Results:
Fifty patients were studied, 20 started Seretide. Symptom scores at entry were higher for Seretide patients than the comparison group (total score 4.2 vs 1.5; p<0.001), and reduced with Seretide, to levels below those seen in the comparison group. Study patients use of relief devices was similar at outset but significantly lower at 9 month follow up (mean 0.7 vs 2.1; 95%CI difference 0.4 to 2.4; p<0.01). Daily dosages of inhaled steroid were significantly higher at entry for the Seretide group (mean 908mcgs vs 648; p=0.041) and were reduced with Seretide to 476mcgs at 9 months (p=0.002) and 467mcgs (p=0.008) at 19 months. Mean 6 month treatment costs for study patients were higher at entry (£146.85 vs £82.74; p=0.12), rose with the addition of Seretide at 9 months (£165.27 vs £80.92; p=0.001) but were significantly reduced at 19 months(£97.35 vs £72.96; p=0.35, Seretide patients' mean cost reduction £67.92; 95%CI £21.24 to £114.60; p<0.01).
Conclusions:
Seretide is effective in treating symptomatic asthma in primary care, reducing symptom scores, reliever use, and mean daily steroid requirements. When symptoms are taken into account, it also appears to be cost-effective, and treatment costs are reduced after extended follow up without loss of benefit.
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