National Jewish Health, Denver, Colorado, USA.
Allergy Asthma Proc. 2010 Jan-Feb;31(1):68-75. doi: 10.2500/aap.2010.31.3306.
Limited information exists comparing fluticasone propionate/salmeterol combination (FSC) versus montelukast (MON) in patients with coexistent asthma and allergic rhinitis. The purpose of this study was to compare the addition of MON to patients receiving FSC on asthma control while experiencing asthma and allergy symptoms. Additionally, the effect of fluticasone propionate aqueous nasal spray (FPANS) and MON were assessed in allergic rhinitis control. Symptomatic patients (n = 1385) with asthma and seasonal allergic rhinitis were randomized to receive FSC, 100/50 micrograms twice daily; FSC twice daily + FPANS, 200 micrograms once daily; FSC twice daily + MON, 10 mg once daily; or MON once daily for 4 weeks during the allergy pollen season. Patients recorded peak expiratory flow, rescue albuterol use, and asthma and rhinitis symptoms. No additional improvements in overall asthma control were seen when MON was added to FSC. Treatment with FSC produced significant (p < 0.001) improvements in all clinical and patient-reported measures versus MON. FSC + FPANS was superior to FSC + MON (p < or = 0.001) in improving daytime and nighttime total nasal symptom scores. Adverse events were similar. In patients with asthma and allergic rhinitis, adding MON to FSC provided no additional benefit in asthma control. FSC resulted in superior improvement in asthma control compared with MON. FPANS also provided superior nasal symptom control versus MON in allergic patients treated with FSC for asthma. Optimal disease control in patients with asthma and allergic rhinitis should be achieved by the most effective therapy directed toward each disease component.
关于同时患有哮喘和变应性鼻炎的患者中丙酸氟替卡松/沙美特罗联合制剂（FSC）与孟鲁司特（MON）的比较，相关信息有限。本研究的目的是比较在哮喘和过敏症状同时存在的情况下，将 MON 添加到接受 FSC 治疗的患者中对哮喘控制的影响。此外，还评估了丙酸氟替卡松水剂鼻腔喷雾（FPANS）和 MON 对变应性鼻炎控制的作用。有哮喘和季节性变应性鼻炎症状的患者（n = 1385）被随机分配接受以下治疗：每天两次接受 FSC，100/50 微克；每天一次接受 FSC 加 FPANS，200 微克；每天一次接受 FSC 加 MON，10 mg；或在花粉季节每天一次接受 MON，治疗 4 周。患者记录呼气峰流速、急救沙丁胺醇使用情况以及哮喘和鼻炎症状。当 MON 添加到 FSC 中时，并未观察到整体哮喘控制的进一步改善。与 MON 相比，接受 FSC 治疗可显著（p < 0.001）改善所有临床和患者报告的指标。FSC + FPANS 在改善日间和夜间总鼻部症状评分方面优于 FSC + MON（p < or = 0.001）。不良反应相似。在患有哮喘和变应性鼻炎的患者中，在 FSC 中添加 MON 并不能改善哮喘控制。FSC 与 MON 相比，可显著改善哮喘控制。在接受 FSC 治疗哮喘的变应性鼻炎患者中，FPANS 也可提供优于 MON 的鼻部症状控制。为了实现哮喘和变应性鼻炎患者的最佳疾病控制，应针对每种疾病成分采用最有效的治疗方法。
