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

MedStar author(s):
Citation: Annals of the American Thoracic Society. 12(6):798-806, 2015 Jun.PMID: 25756308Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Adrenergic beta-2 Receptor Agonists | *Asthma/dt [Drug Therapy] | *Glucocorticoids | Administration, Inhalation | Adrenergic beta-2 Receptor Agonists/ad [Administration & Dosage] | Adrenergic beta-2 Receptor Agonists/ae [Adverse Effects] | Adult | Anti-Asthmatic Agents/ad [Administration & Dosage] | Anti-Asthmatic Agents/ae [Adverse Effects] | Asthma/ep [Epidemiology] | Asthma/pp [Physiopathology] | Cohort Studies | Comparative Effectiveness Research | Databases, Factual | Delayed-Action Preparations | Disease Progression | Dose-Response Relationship, Drug | Drug Therapy, Combination/mt [Methods] | Female | Glucocorticoids/ad [Administration & Dosage] | Glucocorticoids/ae [Adverse Effects] | Great Britain/ep [Epidemiology] | Humans | Male | Middle Aged | Outcome Assessment (Health Care)Year: 2015ISSN:
  • 2325-6621
Name of journal: Annals of the American Thoracic SocietyAbstract: CONCLUSIONS: When applied to a broad primary care population, antiinflammatory therapy using 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.MEASUREMENTS AND MAIN RESULTS: The odds of asthma control and rates of severe exacerbations over one outcome year were comparable with increased inhaled corticosteroid dose versus added LABA. The adjusted odds ratios (95% confidence interval) for achieving asthma control with increased inhaled corticosteroid dose versus inhaled corticosteroid/LABA were 0.99 (0.88-1.12) for small-particle inhaled corticosteroid (n = 3,036 per cohort) and 0.85 (0.67-1.07) for standard size-particle inhaled corticosteroid (n = 809 per cohort). The adjusted rate ratios (95% confidence interval) 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.METHODS: We performed a historical matched cohort study using large primary care databases to compare asthma step-up therapy with small- and standard size-particle inhaled corticosteroid versus added LABA for patients 12-80 years old. As outcomes, we examined a composite of asthma control and rates of severe exacerbations.OBJECTIVES: To compare the effectiveness of stepping up asthma therapy with an increased dose of various types of inhaled corticosteroid as compared with add-on LABA.RATIONALE: Guidelines advocate adding long-acting beta-agonist (LABA) to inhaled corticosteroid as the preferred step-up therapy to increasing inhaled corticosteroid dose for patients with uncontrolled asthma on inhaled corticosteroid monotherapy. However, less than 5% of patients with asthma qualify for the randomized controlled trials on which guidelines are based. Thus, real-world data are needed to complement the results of randomized trials with narrow entry criteria.All authors: Burden A, Colice G, Dorinsky PM, Grigg J, Guilbert TW, Hillyer EV, Israel E, Martin RJ, Postma DS, Price DB, Roche N, Thomas V, van Aalderen WM, von Ziegenweidt JFiscal year: FY2015Date added to catalog: 2016-05-24
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Item type Current library Call number Status Date due Barcode
Journal Article MedStar Authors Catalog 25756308 Available 25756308

CONCLUSIONS: When applied to a broad primary care population, antiinflammatory therapy using 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.

MEASUREMENTS AND MAIN RESULTS: The odds of asthma control and rates of severe exacerbations over one outcome year were comparable with increased inhaled corticosteroid dose versus added LABA. The adjusted odds ratios (95% confidence interval) for achieving asthma control with increased inhaled corticosteroid dose versus inhaled corticosteroid/LABA were 0.99 (0.88-1.12) for small-particle inhaled corticosteroid (n = 3,036 per cohort) and 0.85 (0.67-1.07) for standard size-particle inhaled corticosteroid (n = 809 per cohort). The adjusted rate ratios (95% confidence interval) 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.

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

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

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

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