Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler

Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effectiv...

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Main Authors: David B. Price, Gene Colice, Elliot Israel, Nicolas Roche, Dirkje S. Postma, Theresa W. Guilbert, Willem M.C. van Aalderen, Jonathan Grigg, Elizabeth V. Hillyer, Victoria Thomas, Richard J. Martin
Format: Article
Language:English
Published: European Respiratory Society 2016-05-01
Series:ERJ Open Research
Online Access:http://openres.ersjournals.com/content/2/2/00106-2015.full
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author David B. Price
Gene Colice
Elliot Israel
Nicolas Roche
Dirkje S. Postma
Theresa W. Guilbert
Willem M.C. van Aalderen
Jonathan Grigg
Elizabeth V. Hillyer
Victoria Thomas
Richard J. Martin
author_facet David B. Price
Gene Colice
Elliot Israel
Nicolas Roche
Dirkje S. Postma
Theresa W. Guilbert
Willem M.C. van Aalderen
Jonathan Grigg
Elizabeth V. Hillyer
Victoria Thomas
Richard J. Martin
author_sort David B. Price
collection DOAJ
description Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effective, and whether LABA should be administered by separate or combination inhalers. This historical, matched cohort study compared asthma-related outcomes for patients (aged 12–80 years) prescribed step-up therapy as a ≥50% extrafine ICS dose increase or add-on LABA, via either a separate inhaler or a fine-particle ICS/LABA fixed-dose combination (FDC) inhaler. Risk-domain asthma control was the primary end-point in comparisons of cohorts matched for asthma severity and control during the baseline year. After 1:2 cohort matching, the increased extrafine ICS versus separate ICS+LABA cohorts included 3232 and 6464 patients, respectively, and the fine-particle ICS/LABA FDC versus separate ICS+LABA cohorts included 7529 and 15 058 patients, respectively (overall mean age 42 years; 61–62% females). Over one outcome year, adjusted OR (95% CI) for achieving asthma control were 1.25 (1.13–1.38) for increased ICS versus separate ICS+LABA and 1.06 (1.05–1.09) for ICS/LABA FDC versus separate ICS+LABA. For patients with asthma, increased dose of extrafine-particle ICS, or add-on LABA via ICS/LABA combination inhaler, is associated with significantly better outcomes than ICS+LABA via separate inhalers.
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spelling doaj.art-f099a79e18b4403a85121c33b18620a82022-12-21T19:53:59ZengEuropean Respiratory SocietyERJ Open Research2312-05412016-05-012210.1183/23120541.00106-201500106-2015Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhalerDavid B. Price0Gene Colice1Elliot Israel2Nicolas Roche3Dirkje S. Postma4Theresa W. Guilbert5Willem M.C. van Aalderen6Jonathan Grigg7Elizabeth V. Hillyer8Victoria Thomas9Richard J. Martin10 Academic Primary Care, University of Aberdeen, Aberdeen, UK Washington Hospital Center and George Washington University School of Medicine, Washington, DC, USA Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA Emma Children's Hospital AMC, Amsterdam, The Netherlands Blizard Institute, Queen Mary University of London, London, UK Observational and Pragmatic Research Institute, Singapore, Singapore Observational and Pragmatic Research Institute, Singapore, Singapore National Jewish Health and the University of Colorado Denver, Denver, CO, USA Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effective, and whether LABA should be administered by separate or combination inhalers. This historical, matched cohort study compared asthma-related outcomes for patients (aged 12–80 years) prescribed step-up therapy as a ≥50% extrafine ICS dose increase or add-on LABA, via either a separate inhaler or a fine-particle ICS/LABA fixed-dose combination (FDC) inhaler. Risk-domain asthma control was the primary end-point in comparisons of cohorts matched for asthma severity and control during the baseline year. After 1:2 cohort matching, the increased extrafine ICS versus separate ICS+LABA cohorts included 3232 and 6464 patients, respectively, and the fine-particle ICS/LABA FDC versus separate ICS+LABA cohorts included 7529 and 15 058 patients, respectively (overall mean age 42 years; 61–62% females). Over one outcome year, adjusted OR (95% CI) for achieving asthma control were 1.25 (1.13–1.38) for increased ICS versus separate ICS+LABA and 1.06 (1.05–1.09) for ICS/LABA FDC versus separate ICS+LABA. For patients with asthma, increased dose of extrafine-particle ICS, or add-on LABA via ICS/LABA combination inhaler, is associated with significantly better outcomes than ICS+LABA via separate inhalers.http://openres.ersjournals.com/content/2/2/00106-2015.full
spellingShingle David B. Price
Gene Colice
Elliot Israel
Nicolas Roche
Dirkje S. Postma
Theresa W. Guilbert
Willem M.C. van Aalderen
Jonathan Grigg
Elizabeth V. Hillyer
Victoria Thomas
Richard J. Martin
Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
ERJ Open Research
title Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
title_full Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
title_fullStr Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
title_full_unstemmed Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
title_short Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler
title_sort add on laba in a separate inhaler as asthma step up therapy versus increased dose of ics or ics laba combination inhaler
url http://openres.ersjournals.com/content/2/2/00106-2015.full
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