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

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

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Abstract

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.

Original languageEnglish
Article number00106-2015
JournalERS Monograph
Volume2
Issue number2
DOIs
Publication statusPublished - 1 Apr 2016

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Nebulizers and Vaporizers
Adrenal Cortex Hormones
Asthma
Therapeutics
Particle Size

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler. / Price, David B.; Colice, Gene; Israel, Elliot; Roche, Nicolas; Postma, Dirkje S.; Guilbert, Theresa W.; van Aalderen, Willem M C; Grigg, Jonathan; Hillyer, Elizabeth V.; Thomas, Victoria; Martin, Richard J.

In: ERS Monograph, Vol. 2, No. 2, 00106-2015, 01.04.2016.

Research output: Contribution to journalArticle

Price, DB, Colice, G, Israel, E, Roche, N, Postma, DS, Guilbert, TW, van Aalderen, WMC, Grigg, J, Hillyer, EV, Thomas, V & Martin, RJ 2016, 'Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler' ERS Monograph, vol. 2, no. 2, 00106-2015. https://doi.org/10.1183/23120541.00106-2015
Price, David B. ; Colice, Gene ; Israel, Elliot ; Roche, Nicolas ; Postma, Dirkje S. ; Guilbert, Theresa W. ; van Aalderen, Willem M C ; Grigg, Jonathan ; Hillyer, Elizabeth V. ; Thomas, Victoria ; Martin, Richard J. / Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler. In: ERS Monograph. 2016 ; Vol. 2, No. 2.
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abstract = "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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AU - Postma, Dirkje S.

AU - Guilbert, Theresa W.

AU - van Aalderen, Willem M C

AU - Grigg, Jonathan

AU - Hillyer, Elizabeth V.

AU - Thomas, Victoria

AU - Martin, Richard J.

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