Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study - PubMed (original) (raw)

Clinical Trial

. 2004 Oct 15;170(8):836-44.

doi: 10.1164/rccm.200401-033OC. Epub 2004 Jul 15.

Affiliations

• PMID: 15256389
• DOI: 10.1164/rccm.200401-033OC

Clinical Trial

Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study

Eric D Bateman et al. Am J Respir Crit Care Med. 2004.

Abstract

For most patients, asthma is not controlled as defined by guidelines; whether this is achievable has not been prospectively studied. A 1-year, randomized, stratified, double-blind, parallel-group study of 3,421 patients with uncontrolled asthma compared fluticasone propionate and salmeterol/fluticasone in achieving two rigorous, composite, guideline-based measures of control: totally and well-controlled asthma. Treatment was stepped-up until total control was achieved (or maximum 500 microg corticosteroid twice a day). Significantly more patients in each stratum (previously corticosteroid-free, low- and moderate-dose corticosteroid users) achieved control with salmeterol/fluticasone than fluticasone. Total control was achieved across all strata: 520 (31%) versus 326 (19%) patients after dose escalation (p < 0.001) and 690 (41%) versus 468 (28%) at 1 year for salmeterol/fluticasone and fluticasone, respectively. Asthma became well controlled in 1,071 (63%) versus 846 (50%) after dose escalation (p < 0.001) and 1,204 (71%) versus 988 (59%) at 1 year. Control was achieved more rapidly and at a lower corticosteroid dose with salmeterol/fluticasone versus fluticasone. Across all strata, 68% and 76% of the patients receiving salmeterol/fluticasone and fluticasone, respectively, were on the highest dose at the end of treatment. Exacerbation rates (0.07-0.27 per patient per year) and improvement in health status were significantly better with salmeterol/fluticasone. This study confirms that the goal of guideline-derived asthma control was achieved in a majority of the patients.

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Comment in

• Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study.
  Barnes NC. Barnes NC. Am J Respir Crit Care Med. 2004 Oct 15;170(8):830-1. doi: 10.1164/rccm.2408006. Am J Respir Crit Care Med. 2004. PMID: 15475405 No abstract available.
• The GOAL study: designed to favor a long-acting beta2-agonist?
  Currie GP, Lee DK. Currie GP, et al. Am J Respir Crit Care Med. 2005 May 1;171(9):1060-1; author reply 1061. doi: 10.1164/ajrccm.171.9.951. Am J Respir Crit Care Med. 2005. PMID: 15849330 No abstract available.
• An own GOAL or a real breakthrough?
  Fardon TC, Lipworth BJ. Fardon TC, et al. Am J Respir Crit Care Med. 2005 May 1;171(9):1060; author reply 1061. doi: 10.1164/ajrccm.171.9.950. Am J Respir Crit Care Med. 2005. PMID: 15849331 No abstract available.

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