By Sandra Ripley Distelhorst
SEATTLE, Wash -- November 10, 2008 -- Some treatments to control asthma may be less effective in patients who are overweight or obese, researchers reported at the American College of Allergy, Asthma & Immunology (ACAAI) annual conference.
Although obesity may contribute to the development and clinical expression of asthma, there is still uncertainty as to how obesity influences response to asthma medications.
E. Rand Sutherland, MD, MPH, National Jewish Medical and Research Center, Denver, Colorado, and colleagues conducted a post hoc analysis of 2 studies to evaluate relative responsiveness to the inhaled corticosteroid fluticasone propionate and the oral leukotriene modifier montelukast in overweight and obese patients. Dr. Sutherland presented the results here on November 8.
The analysis pooled data from 2 previously published, double-blind, randomised, parallel-group, 12-week trials that compared fluticasone and montelukast in 1,052 patients who were at least 15 years of age, had a baseline forced expiratory volume in 1 second (FEV1) of 50% to 80%, and had demonstrated >15% reversibility with albuterol.
Outcome measures included mean change in morning peak flow, daily albuterol use, and daily asthma symptom scores. Similar findings were observed for the 6% of the study patients with a BMI >=40 kg/m2.
The study found that use of inhaled corticosteroid fluticasone propionate resulted in greater percent improvement for all outcomes across all BMIs and was statistically superior to use of oral montelukast in all BMI categories except underweight for morning peak flow (P = .002), albuterol use (P = .02), and daily symptom score (P = .04).
Dr. Sutherland and colleagues noted that in the previous studies, where BMI was not a study variable, similar results were found in comparing fluticasone propionate therapy with montelukast therapy: greater responsiveness was associated with fluticasone propionate therapy.
In those previous studies, patients were more satisfied in being treated with the inhaled corticosteroid fluticasone propionate compared with the orally administered montelukast. Also, physicians rated fluticasone propionate as being a more effective agent than montelukast.
Funding for this study was provided by GlaxoSmithKline.
[Presentation Title: The Effect of Increasing Body Mass Index (BMI) on the Responsiveness to Asthma Controllers Fluticasone Propionate (FP) and Montelukast (MON). Abstract P96]
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