Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

Steve Turner; Kathryn Richardson; Clare Murray; Mike Thomas; Elizabeth V Hillyer; Anne Burden; David B Price

doi:10.1016/j.jaip.2016.06.009

Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

Steve Turner^* (Corresponding Author), Kathryn Richardson, Clare Murray, Mike Thomas, Elizabeth V Hillyer, Anne Burden, David B Price

^*Corresponding author for this work

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Abstract

Background

Adding a long-acting β₂-agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler is the UK guideline recommendation for children aged more than 4 years with uncontrolled asthma. The evidence of benefit of adding an FDC inhaler over a separate LABA inhaler is limited.

Objective

The objective of this study was to compare the effectiveness of a LABA added as an FDC inhaler, and as a separate inhaler, in children with uncontrolled asthma.

Methods

Two UK primary care databases were used to create a matched cohort study with a 2-year follow-up period. We included children prescribed their first step-up from ICS monotherapy. Two cohorts were formed for children receiving an add-on LABA as an FDC inhaler, or a separate LABA inhaler. Matching variables and confounders were identified by comparing characteristics during a baseline year of follow-up. Outcomes were examined during the subsequent year. The primary outcome was an adjusted odds ratio for overall asthma control (defined as follows: no asthma-related hospital admission or emergency room visit, prescription for oral corticosteroids or antibiotic with evidence of respiratory consultation, and ≤2 puffs of short-acting β-agonist daily).

Results

The final study consisted of 1330 children in each cohort (mean age 9 years; 59% male). In the separate ICS+LABA cohort, the odds of achieving overall asthma control were lower (adjusted odds ratio, 0.77 [95% confidence interval, 0.66-0.91]; P = .001) compared with the FDC cohort.

Conclusion

The study demonstrates a small but significant benefit in achieving asthma control from an add-on LABA as an FDC, compared with a separate inhaler and this supports current guideline recommendations.

Original language	English
Pages (from-to)	99-106.e3
Number of pages	8
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	5
Issue number	1
Early online date	Jul 2016
DOIs	https://doi.org/10.1016/j.jaip.2016.06.009
Publication status	Published - Jan 2017

Bibliographical note

Acknowledgments
The authors thank Prof. Stanley Szefler for his comments on the paper and Lisa Law for help with editing. This study was funded by the Respiratory Effectiveness Group.

Keywords

asthma
child
inhaled corticosteroid
long-acting b-agonist
step-up therapy

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Accepted Manuscript
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 1.68 MBLicence: CC BY-NC-ND

Cite this

Turner, S., Richardson, K., Murray, C., Thomas, M., Hillyer, E. V., Burden, A., & Price, D. B. (2017). Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids. The Journal of Allergy and Clinical Immunology: In Practice, 5(1), 99-106.e3. https://doi.org/10.1016/j.jaip.2016.06.009

Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids. / Turner, Steve (Corresponding Author); Richardson, Kathryn; Murray, Clare et al.
In: The Journal of Allergy and Clinical Immunology: In Practice, Vol. 5, No. 1, 01.2017, p. 99-106.e3.

Research output: Contribution to journal › Article › peer-review

Turner, S, Richardson, K, Murray, C, Thomas, M, Hillyer, EV, Burden, A & Price, DB 2017, 'Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids', The Journal of Allergy and Clinical Immunology: In Practice, vol. 5, no. 1, pp. 99-106.e3. https://doi.org/10.1016/j.jaip.2016.06.009

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abstract = "BackgroundAdding a long-acting β2-agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler is the UK guideline recommendation for children aged more than 4 years with uncontrolled asthma. The evidence of benefit of adding an FDC inhaler over a separate LABA inhaler is limited.ObjectiveThe objective of this study was to compare the effectiveness of a LABA added as an FDC inhaler, and as a separate inhaler, in children with uncontrolled asthma.MethodsTwo UK primary care databases were used to create a matched cohort study with a 2-year follow-up period. We included children prescribed their first step-up from ICS monotherapy. Two cohorts were formed for children receiving an add-on LABA as an FDC inhaler, or a separate LABA inhaler. Matching variables and confounders were identified by comparing characteristics during a baseline year of follow-up. Outcomes were examined during the subsequent year. The primary outcome was an adjusted odds ratio for overall asthma control (defined as follows: no asthma-related hospital admission or emergency room visit, prescription for oral corticosteroids or antibiotic with evidence of respiratory consultation, and ≤2 puffs of short-acting β-agonist daily).ResultsThe final study consisted of 1330 children in each cohort (mean age 9 years; 59% male). In the separate ICS+LABA cohort, the odds of achieving overall asthma control were lower (adjusted odds ratio, 0.77 [95% confidence interval, 0.66-0.91]; P = .001) compared with the FDC cohort.ConclusionThe study demonstrates a small but significant benefit in achieving asthma control from an add-on LABA as an FDC, compared with a separate inhaler and this supports current guideline recommendations.",

keywords = "asthma, child, inhaled corticosteroid, long-acting b-agonist, step-up therapy",

author = "Steve Turner and Kathryn Richardson and Clare Murray and Mike Thomas and Hillyer, {Elizabeth V} and Anne Burden and Price, {David B}",

note = "Acknowledgments The authors thank Prof. Stanley Szefler for his comments on the paper and Lisa Law for help with editing. This study was funded by the Respiratory Effectiveness Group. ",

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T1 - Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

AU - Turner, Steve

AU - Richardson, Kathryn

AU - Murray, Clare

AU - Thomas, Mike

AU - Hillyer, Elizabeth V

AU - Burden, Anne

AU - Price, David B

N1 - Acknowledgments The authors thank Prof. Stanley Szefler for his comments on the paper and Lisa Law for help with editing. This study was funded by the Respiratory Effectiveness Group.

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N2 - BackgroundAdding a long-acting β2-agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler is the UK guideline recommendation for children aged more than 4 years with uncontrolled asthma. The evidence of benefit of adding an FDC inhaler over a separate LABA inhaler is limited.ObjectiveThe objective of this study was to compare the effectiveness of a LABA added as an FDC inhaler, and as a separate inhaler, in children with uncontrolled asthma.MethodsTwo UK primary care databases were used to create a matched cohort study with a 2-year follow-up period. We included children prescribed their first step-up from ICS monotherapy. Two cohorts were formed for children receiving an add-on LABA as an FDC inhaler, or a separate LABA inhaler. Matching variables and confounders were identified by comparing characteristics during a baseline year of follow-up. Outcomes were examined during the subsequent year. The primary outcome was an adjusted odds ratio for overall asthma control (defined as follows: no asthma-related hospital admission or emergency room visit, prescription for oral corticosteroids or antibiotic with evidence of respiratory consultation, and ≤2 puffs of short-acting β-agonist daily).ResultsThe final study consisted of 1330 children in each cohort (mean age 9 years; 59% male). In the separate ICS+LABA cohort, the odds of achieving overall asthma control were lower (adjusted odds ratio, 0.77 [95% confidence interval, 0.66-0.91]; P = .001) compared with the FDC cohort.ConclusionThe study demonstrates a small but significant benefit in achieving asthma control from an add-on LABA as an FDC, compared with a separate inhaler and this supports current guideline recommendations.

AB - BackgroundAdding a long-acting β2-agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler is the UK guideline recommendation for children aged more than 4 years with uncontrolled asthma. The evidence of benefit of adding an FDC inhaler over a separate LABA inhaler is limited.ObjectiveThe objective of this study was to compare the effectiveness of a LABA added as an FDC inhaler, and as a separate inhaler, in children with uncontrolled asthma.MethodsTwo UK primary care databases were used to create a matched cohort study with a 2-year follow-up period. We included children prescribed their first step-up from ICS monotherapy. Two cohorts were formed for children receiving an add-on LABA as an FDC inhaler, or a separate LABA inhaler. Matching variables and confounders were identified by comparing characteristics during a baseline year of follow-up. Outcomes were examined during the subsequent year. The primary outcome was an adjusted odds ratio for overall asthma control (defined as follows: no asthma-related hospital admission or emergency room visit, prescription for oral corticosteroids or antibiotic with evidence of respiratory consultation, and ≤2 puffs of short-acting β-agonist daily).ResultsThe final study consisted of 1330 children in each cohort (mean age 9 years; 59% male). In the separate ICS+LABA cohort, the odds of achieving overall asthma control were lower (adjusted odds ratio, 0.77 [95% confidence interval, 0.66-0.91]; P = .001) compared with the FDC cohort.ConclusionThe study demonstrates a small but significant benefit in achieving asthma control from an add-on LABA as an FDC, compared with a separate inhaler and this supports current guideline recommendations.

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SN - 2213-2198

VL - 5

SP - 99-106.e3

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

IS - 1

ER -

Long-Acting β-Agonist in Combination or Separate Inhaler as Step-Up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids

Abstract

Bibliographical note

Keywords

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