Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting β-Agonist for Step-Up Therapy in Asthma

Elliot Israel, Nicolas Roche, Richard J Martin, Gene Colice, Paul M Dorinsky, Dirkje S Postma, Theresa W Guilbert, Willem Mc van Aalderen, Jonathan Grigg, Elizabeth V Hillyer, Anne Burden, Julie von Ziegenweidt, Victoria Thomas, David B. Price

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

RATIONALE: Guidelines advocate adding long-acting beta-agonist (LABA) to inhaled corticosteroid (ICS) as the preferred step-up therapy to increasing inhaled corticosteroid dose for patients with uncontrolled asthma on inhaled corticosteroid monotherapy. However, <5% of patients with asthma qualify for the randomized controlled trials on which guidelines are based. Thus, real-world data are needed to complement results of randomized trials with narrow entry criteria.

OBJECTIVES: To compare the effectiveness of stepping up asthma therapy with an increased dose of different types of inhaled corticosteroid as compared with add-on LABA.

METHODS: We performed a historical matched cohort study utilizing large primary care databases to compare asthma step-up therapy with small- and standard size-particle inhaled corticosteroid vs. added LABA for patients 12-80 years old. As outcomes, we examined a composite of asthma control and rates of severe exacerbations.

MEASUREMENTS AND MAIN RESULTS: The odds of asthma control and rates of severe exacerbations over 1 outcome year were comparable with increased inhaled corticosteroid dose vs. added LABA. The adjusted odds ratios (95% CI) for achieving asthma control with increased inhaled corticosteroid dose vs inhaled corticosteroid/LABA were 0.99 (0.88-1.12) for small-particle inhaled corticosteroid (n=3036 per cohort) and 0.85 (0.67-1.07) for standard size-particle inhaled corticosteroid (n=809 per cohort). The adjusted rate ratios (95% CI) for severe exacerbations, compared with inhaled corticosteroid/LABA combination inhaler, were 1.04 (0.91-1.20) and 1.18 (0.92-1.54), respectively. The results were not affected by smoking status.

CONCLUSIONS: When applied to a broad primary care population, anti-inflammatory therapy utilizing increased doses of small- or standard size-particle inhaled corticosteroid is as effective as adding LABA, as measured by outcomes important to both patients and providers. Real-world populations and outcomes need to be taken into consideration when formulating treatment recommendations.

Original languageEnglish
Pages (from-to)798-806
Number of pages9
JournalAnnals of the American Thoracic Society
Volume12
Issue number6
Early online date10 Mar 2015
DOIs
Publication statusPublished - 1 Jun 2015

Keywords

  • adrenergic β2-agonists
  • antiasthmatic agents
  • bronchodilator agents
  • disease exacerbation
  • glucocorticoids

Fingerprint Dive into the research topics of 'Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting β-Agonist for Step-Up Therapy in Asthma'. Together they form a unique fingerprint.

  • Cite this

    Israel, E., Roche, N., Martin, R. J., Colice, G., Dorinsky, P. M., Postma, D. S., Guilbert, T. W., van Aalderen, W. M., Grigg, J., Hillyer, E. V., Burden, A., von Ziegenweidt, J., Thomas, V., & Price, D. B. (2015). Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting β-Agonist for Step-Up Therapy in Asthma. Annals of the American Thoracic Society, 12(6), 798-806. https://doi.org/10.1513/AnnalsATS.201412-580OC