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Published ahead of print on July 15, 2004, doi:10.1164/rccm.200401-033OC
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American Journal of Respiratory and Critical Care Medicine Vol 170. pp. 836-844, (2004)
© 2004 American Thoracic Society
doi: 10.1164/rccm.200401-033OC

Can Guideline-defined Asthma Control Be Achieved?

The Gaining Optimal Asthma ControL Study

Eric D. Bateman, Homer A. Boushey, Jean Bousquet, William W. Busse, Tim J. H. Clark, Romain A. Pauwels and Søren E. Pedersen for the GOAL Investigators Group

University of Cape Town, Cape Town, South Africa; University of California, San Francisco, San Francisco, California; Hôpital Arnaud De Villeneuve, Montpellier, France; University of Wisconsin Medical School, Madison, Wisconsin; Imperial College, London, United Kingdom; Ghent University Hospital, Ghent, Belgium; and University of Southern Denmark, Kolding Hospital, Kolding, Denmark

Correspondence and requests for reprints should be addressed to Eric D. Bateman, M.D., F.R.C.P., UCT Lung Institute, P.O. Box 34560, Groote Schuur 7937, Cape Town, South Africa. E-mail: ebateman{at}uctgsh1.uct.ac.za

For most patients, asthma is not controlled as defined by guidelines; whether this is achievable has not been prospectively studied. A 1-year, randomized, stratified, double-blind, parallel-group study of 3,421 patients with uncontrolled asthma compared fluticasone propionate and salmeterol/fluticasone in achieving two rigorous, composite, guideline-based measures of control: totally and well-controlled asthma. Treatment was stepped-up until total control was achieved (or maximum 500 µg corticosteroid twice a day). Significantly more patients in each stratum (previously corticosteroid-free, low- and moderate-dose corticosteroid users) achieved control with salmeterol/fluticasone than fluticasone. Total control was achieved across all strata: 520 (31%) versus 326 (19%) patients after dose escalation (p < 0.001) and 690 (41%) versus 468 (28%) at 1 year for salmeterol/fluticasone and fluticasone, respectively. Asthma became well controlled in 1,071 (63%) versus 846 (50%) after dose escalation (p < 0.001) and 1,204 (71%) versus 988 (59%) at 1 year. Control was achieved more rapidly and at a lower corticosteroid dose with salmeterol/fluticasone versus fluticasone. Across all strata, 68% and 76% of the patients receiving salmeterol/fluticasone and fluticasone, respectively, were on the highest dose at the end of treatment. Exacerbation rates (0.07–0.27 per patient per year) and improvement in health status were significantly better with salmeterol/fluticasone. This study confirms that the goal of guideline-derived asthma control was achieved in a majority of the patients.

Key Words: antiasthmatic agents • fluticasone propionate • guidelines • quality of life • salmeterol




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G. P. Currie, D. K. C. Lee, and P. Srivastava
Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma?
Chest, October 1, 2005; 128(4): 2954 - 2962.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
P. M. O'Byrne
Daily Inhaled Corticosteroid Treatment Should Be Prescribed for Mild Persistent Asthma
Am. J. Respir. Crit. Care Med., August 15, 2005; 172(4): 410 - 412.
[Full Text] [PDF]

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 Evid. Based Med.Home page
P J. Rees
Maintenance plus as needed budesonide plus formoterol was better than fixed dose for severe exacerbations in asthma
Evid. Based Med., August 1, 2005; 10(4): 116 - 116.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
E. D. Bateman
GOAL--Asthma Control, but at What Cost?
Am. J. Respir. Crit. Care Med., July 15, 2005; 172(2): 255 - 256.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
G. R. G. Todd
GOAL--Asthma Control, but at What Cost?
Am. J. Respir. Crit. Care Med., July 15, 2005; 172(2): 254 - 255.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
S. Wenzel
Severe Asthma in Adults
Am. J. Respir. Crit. Care Med., July 15, 2005; 172(2): 149 - 160.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
G. B. Marks
Identifying asthma in population studies: from single entity to a multi-component approach
Eur. Respir. J., July 1, 2005; 26(1): 3 - 5.
[Full Text] [PDF]

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 ChestHome page
M. Gaga, N. Papageorgiou, E. Zervas, D. Gioulekas, and S. Konstantopoulos
Control of Asthma Under Specialist Care: Is It Achieved?
Chest, July 1, 2005; 128(1): 78 - 84.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
M. E. Wechsler and E. Israel
How Pharmacogenomics Will Play a Role in the Management of Asthma
Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 12 - 18.
[Full Text] [PDF]

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 NEJMHome page
A. D. Smith, J. O. Cowan, K. P. Brassett, G. P. Herbison, and D. R. Taylor
Use of Exhaled Nitric Oxide Measurements to Guide Treatment in Chronic Asthma
N. Engl. J. Med., May 26, 2005; 352(21): 2163 - 2173.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
T. C. Fardon and B. J. Lipworth
An Own GOAL or a Real Breakthrough?
Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 1060 - 1060.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
E. D. Bateman and for the GOAL Study Steering Committee
The GOAL Study Designed to Favor a Long-acting {beta}2-Agonist?
Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 1061 - 1061.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
G. P. Currie and D. K. C. Lee
The GOAL Study Designed to Favor a Long-acting {beta}2-Agonist?
Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 1060 - 1061.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
L. Fabbri, S. P. Peters, I. Pavord, S. E. Wenzel, S. C. Lazarus, W. MacNee, F. Lemaire, and E. Abraham
Allergic Rhinitis, Asthma, Airway Biology, and Chronic Obstructive Pulmonary Disease in AJRCCM in 2004
Am. J. Respir. Crit. Care Med., April 1, 2005; 171(7): 686 - 698.
[Full Text] [PDF]

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 BMJHome page
G. P Currie, G. S Devereux, D. K C Lee, and J. G Ayres
Recent developments in asthma management
BMJ, March 12, 2005; 330(7491): 585 - 589.
[Full Text] [PDF]

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 Eur Respir JHome page
P. G. Gibson
Teaching old drugs new tricks: asthma therapy adjusted by patient perception or noninvasive markers
Eur. Respir. J., March 1, 2005; 25(3): 397 - 399.
[Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
P. J. Barnes
A Single Inhaler for Asthma?
Am. J. Respir. Crit. Care Med., January 15, 2005; 171(2): 95 - 96.
[Full Text] [PDF]

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 Eur Respir JHome page
H.K. Reddel
Goals of asthma treatment: how high should we go?
Eur. Respir. J., November 1, 2004; 24(5): 715 - 717.
[Full Text] [PDF]


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