Question 5. Is there a role for fixed dose combination therapy in the management of persistent asthma?

From Chapter 6 of the Philippine Consensus Report on Asthma 2004 by the Philippine College of Chest Physicians.
This guideline starts below.

Is there a role for fixed dose combination therapy in the management of persistent asthma?

Answer

Yes, recent studies suggest that additional clinical benefit can be achieved with fixed dose combination therapy of LABA and ICS.

Summary of Evidence

Numerous researches, all randomized, double-blind, placebo-controlled and parallel group design compared the effects of the fixed combination therapy of salmeterol and fluticasone to either steroid alone (either BDP, budesonide or fluticasone), salmeterol alone and placebo. These studies unequivocally demonstrated that addition of an inhaled LABA to the ICS treatment improves all aspects of asthma control.

The additional clinical benefit derived from the fixed-combination therapy results not only from the LABA-glucocorticoid interaction but also from the steroid-induced transcription of beta-2-adrenoceptor gene with the resultant increased synthesis of the beta-2-receptor protein. This interaction between the LABA and the ICS increased the efficacy of both drugs. Fixed dose combination therapy has likewise been found to be beneficial in terms of other aspects of asthma management such as cost of treatment and patient compliance.