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

Annals of the American Thoracic Society
Elliot IsraelDavid Price

Abstract

Guidelines advocate adding long-acting β-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. 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. 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. 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 corticosteroi...Continue Reading

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Citations

Feb 6, 2017·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Bradley E ChippsJudith R Farrar
Oct 31, 2017·Journal of Managed Care & Specialty Pharmacy·Lindsay G S BengtsonAmi R Buikema
Oct 13, 2016·ERJ Open Research·Tari HaahtelaPaul M O'Byrne
Feb 14, 2018·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Daniel Silveira SerraJosé Henrique Leal-Cardoso
Jun 16, 2015·Annals of the American Thoracic Society·Sharmilee M Nyenhuis, Jerry A Krishnan

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