Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting beta-Agonist for Step-Up Therapy in Asthma.
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
Item type | Current library | Call number | Status | Date due | Barcode |
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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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