Abstract
We report a case study of a 55-year-old white male with severe persistent refractory corticosteroid-dependent asthma receiving inhaled combination therapy with fluticasone propionate 500 μg and salmeterol 50 μg twice-daily in addition to 6-week cycles of oral corticosteroid treatment for the previous 7 months. The patient was switched to high-dose mometasone furoate delivered via a dry powder inhaler (660 μg twice-daily) for 6 weeks.Considerable improvement from baseline in peak expiratory flow, use of rescue medication, and asthma symptoms of coughing and wheezing was observed. The patient discontinued the oral corticosteroid after 1 week of high-dose mometasone furoate treatment. Plasma cortisol value at 8 a.m. was 8.4 μg/dL (normal range, 4.3-22.6 μg/dL) at week 6.
Highlights
Inhaled corticosteroids (ICSs) are the standard controller therapy for management of persistent asthma [1]
We report a case study of a 55-year-old white male with severe persistent refractory corticosteroiddependent asthma receiving inhaled combination therapy with fluticasone propionate 500 μg and salmeterol 50 μg twice-daily in addition to 6-week cycles of oral corticosteroid treatment for the previous 7 months
The patient was switched to high-dose mometasone furoate delivered via a dry powder inhaler (660 μg twice-daily) for 6 weeks
Summary
Inhaled corticosteroids (ICSs) are the standard controller therapy for management of persistent asthma [1]. Approximately 10% of patients are considered to have severe disease These patients are not well controlled despite high-dose ICS and long-acting b2-agonist (LABA) therapy; some of these patients may even require treatment with oral corticosteroids (OCS) [2]. The condition is characterized by the medication requirement for good disease control or persistent symptoms, asthma exacerbations, or airway obstruction regardless of high use of medication Such patients may present with large variations in peak flows, rapid and progressive loss of lung function, severe but chronic airflow limitation, wide-ranging amounts of mucus production, and varying responses to corticosteroids [3]. A novel approach of switching a patient with RCDA on fluticasone propionate (FP) plus salmeterol (SAL) therapy to high-dose mometasone furoate delivered via a dry powder inhaler (MF-DPI) therapy was tested. BID, twice-daily; FPS, fluticasone propionate and salmeterol; MF-DPI, mometasone furoate delivered via a dry powder inhaler; ND, not determined; PEF, peak expiratory flow; puffs/d, puffs per day. *Normal range is 4.3-22.6 μg/dL
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