Can total control of asthma be achieved? The results of the GOAL study

Abstract

Rationale Whether Total Control (equating to clinical remission) of asthma can be achieved has not been investigated. Gaining Optimal Asthma controL (GOAL) assessed this in a 1-year study comparing salmeterol/fluticasone (SFC) to fluticasone propionate (FP) alone. Methods Patients with uncontrolled asthma were allocated to 3 strata based upon prior medication (ICS-naïve [S1]/low-dose ICS [S2]/moderate-dose ICS [S3]), and randomized to SFC (Seretide ®/Advair ®) or FP (Flixotide ®/Flovent ®). Treatment was stepped-up every 12 weeks until Total Control was achieved (or maximum dose reached). Total Control (no symptoms, no rescue medication, no night-awakenings, no exacerbations, no emergency visits, no adverse events and normal lung function) was based on the GINA/NIH guidelines, and evaluated over the last 8 weeks of each 12 week treatment period. Results 3421 patients were randomized to treatment (mean age 40 years (SD: 16.2) and FEV 1 77% at baseline). Significantly more patients achieved Total Control with SFC compared with FP alone: S1 42% vs 31%; S2 32% vs 20%; and S3 19% vs 8%, respectively (all p<0.001). The proportion of patients achieving Total Control at the same or lower dose of ICS was significantly greater with SFC vs FP alone in each stratum; the odds ratios were: S1 1.78; S2 2.19; and S3 2.95 (all p<0.001). Conclusions These data show that the goals of the GINA/NIH guidelines can be achieved and maintained, and that this level of Total Control (equating to clinical remission) is realised in more patients with salmeterol/fluticasone than with fluticasone alone, regardless of previous treatment.