From the FDA Drug Label
Reduction in asthma symptoms and use of rescue VENTOLIN Inhalation Aerosol and improvement in morning and evening PEF also occurred within the first day of treatment with fluticasone propionate and salmeterol inhalation powder, and continued to improve over the 12 weeks of therapy in both trials.
The preferred treatment for mild persistent asthma and perennial allergic rhinitis is not directly stated in the provided drug label. However, based on the information provided, fluticasone propionate and salmeterol inhalation powder may be considered for the treatment of asthma.
- The drug label discusses the efficacy of fluticasone propionate and salmeterol inhalation powder in reducing asthma symptoms and improving lung function in subjects with asthma.
- However, it does not provide direct information on the treatment of perennial allergic rhinitis.
- Therefore, a conservative clinical decision would be to consider fluticasone propionate and salmeterol inhalation powder as a potential treatment option for mild persistent asthma, but not necessarily for perennial allergic rhinitis 1.
From the Research
The preferred treatment for mild persistent asthma with perennial allergic rhinitis is a combination of an inhaled corticosteroid (ICS) and an intranasal corticosteroid, with the option of using exclusive nasally inhaled corticosteroids as an alternative step in management, as suggested by the study 2.
Treatment Approach
For asthma control, a low-dose ICS such as fluticasone (88-220 mcg daily), budesonide (180-360 mcg daily), or beclomethasone (80-240 mcg daily) is recommended as first-line therapy, typically administered twice daily via metered-dose inhaler. A short-acting beta-agonist like albuterol (2 puffs every 4-6 hours as needed) should be prescribed as rescue medication.
Allergic Rhinitis Component
For the allergic rhinitis component, an intranasal corticosteroid such as fluticasone propionate (1-2 sprays per nostril daily), mometasone furoate, or triamcinolone acetonide is recommended. Adding a second-generation antihistamine like cetirizine (10 mg daily), loratadine (10 mg daily), or fexofenadine (180 mg daily) can provide additional symptom relief for rhinitis, as supported by studies 3, 4.
Rationale
This combination approach targets both conditions effectively by addressing the underlying inflammatory processes. ICS medications reduce airway inflammation and hyperresponsiveness in asthma, while intranasal corticosteroids decrease nasal inflammation and congestion. Treating both conditions simultaneously is important as they share common inflammatory pathways, and poor control of rhinitis can worsen asthma symptoms, as highlighted in the study 5. Furthermore, the use of intranasal corticosteroids like ciclesonide does not significantly increase cortisol suppression when coadministered with inhaled corticosteroids, making it a safe option 6.