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- W4245392416 abstract "Thank you for the opportunity to respond to Dr Lipworth’s letter regarding our recent article reporting that the addition of salmeterol to low-dose fluticasone was more effective than the addition of montelukast in controlling asthma symptoms in patients whose asthma was not adequately controlled with fluticasone alone.1Nelson HS Busse WW Kerwin E Church N Emmett A Rickard K et al.Fluticasone propionate/salmeterol combination provides more effective asthma control than low-dose inhaled corticosteroid plus montelukast.J Allergy Clin Immunol. 2000; 106: 1088-1095Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar It is Dr Lipworth’s contention, repeated in both the first and last paragraphs of his letter, that the study was biased by the entry criteria requiring a 12% of baseline increase in FEV1 after 2 inhalations of albuterol. This statement by Dr Lipworth is rather surprising considering a similar requirement for reversibility after inhalation of a short-acting β-agonist is almost universal in protocols studying asthma therapy, including those examining inhaled corticosteroids2Fish JE Karpel JP Craig TJ Bensch GW Noonan M Webb DR et al.Inhaled mometasone furoate reduces oral prednisone requirements while improving respiratory function and health-related quality of life in patients with severe persistent asthma.J Allergy Clin Immunol. 2000; 106: 852-860Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar and both zafirlukast3Virchow JC Prasse A Naya I Summerton L Harris A. Zafirlukast improves asthma control in patients receiving high-dose inhaled corticosteroids.Am J Respir Crit Care Med. 2000; 162: 578-585Crossref PubMed Scopus (196) Google Scholar and montelukast.4Laviolette M Malmstrom K Lu S Chervinsky P Pujet JC Peszek I et al.Montelukast added to inhaled beclomethasone in treatment of asthma.Am J Respir Crit Care Med. 1999; 160: 1862-1868Crossref PubMed Scopus (344) Google Scholar Dr Lipworth then proceeds to dismiss the reduction in asthma symptoms, β-agonist rescue use, and even exacerbations requiring additional, nonprotocol medication as likely reflections of the prolonged bronchodilator activity of salmeterol. Although it was not reported in this study, he might also have dismissed the “clinically important” improvement in asthma-specific quality of life that has also been reported with salmeterol,5Juniper EF Johnston PR Borkhoff CM Guyatt GH Boulet LP Haukioja A. Quality of life in asthma clinical trials: comparison of salmeterol and salbutamol.Am J Respir Crit Care Med. 1995; 151: 66-70Crossref PubMed Scopus (174) Google Scholar probably also due to the prolonged bronchodilation produced by the drug. Even if these responses are due merely to prolonged bronchodilation, it is difficult to believe that they are not important to the patient with poorly controlled asthma. Although we would agree that further studies are needed to examine the effect of all asthma medications on the long-term course of asthma and airway remodeling, the pattern observed during the course of our 12-week study did not suggest that the advantages of salmeterol over montelukast for any of the outcomes were decreasing during the course of the study. Our study thus confirms the similar advantages of salmeterol over another leukotriene antagonist, zafirlukast, previously reported in a study of shorter duration.6Busse WW Nelson HS Wolfe J Kalberg C Yancey SW Rickard K. Comparison of inhaled salmeterol and oral zafirlukast in patients with asthma.J Allergy Clin Immunol. 1999; 103: 1075-1080Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar 1/8/114048" @default.
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- W4245392416 date "2001-04-01" @default.
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- W4245392416 title "Reply" @default.
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- W4245392416 doi "https://doi.org/10.1067/mai.2001.114048" @default.
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