Patients using ICSs during GL1 , but only using ICSs 0 % to 50 % of the time during GL2 ( n = 56 of 79 ) , had significantly accelerated annual FEV1 decline compared with GL1 ( difference GL2-GL1 [ 95 % CI ] : 30-month treatment with fluticasone and salmeterol , -68 mL/y [ -112 to -25 ] , P = .002 ; 30-month treatment with fluticasone , -73 mL/y [ -119 to -26 ] , P = .002 ) , accompanied by deterioration in AHR and QOL .