The University of Southampton
University of Southampton Institutional Repository

High-dose inhaled corticosteroids versus add-on long acting beta agonists in asthma: an observational study

Thomas, M., von Ziegenweidt, J., Lee, A. and Price, D. (2009) High-dose inhaled corticosteroids versus add-on long acting beta agonists in asthma: an observational study Journal of Allergy and Clinical Immunology, 123, (1), pp. 116-121. (doi:10.1016/j.jaci.2008.09.035). (PMID:18986690).

Record type: Article

Abstract

Background
Guidelines recommend that for patients uncontrolled on inhaled corticosteroids (ICSs), step-up options include an increase in ICS dosage or addition of a long-acting ?-agonist (LABA). Controversy persists about the best option in routine practice.
Objective
To compare asthma outcomes in patients whose first step-up from ICS monotherapy was by addition of LABA (LABA cohort) or increase in ICS dosage or formulation (ICS cohort).
Methods
Observational study using the General Practice Research Database, comparing outcomes in the following 12 months with regression modeling allowing for baseline cohort differences: age, sex, socioeconomic status, body mass index, comorbidity (rhinitis, heart disease), smoking status, short-acting ?-agonist (SABA) use, oral corticosteroid use, and use of asthma complicating medication.
Results
We found 46,930 patients in the ICS and 17,418 in the LABA cohort. In adjusted analysis, the odds ratio (95% CI) of successful treatment (no hospitalization, no oral corticosteroid use, average daily SABA use <1 dose/d) was lower in the ICS cohort (0.75; 0.72-0.79). The adjusted odds ratio of needing rescue SABA prescriptions was higher in the ICS cohort (1.67; 1.59-1.76). However, the adjusted odds of using any oral corticosteroids were lower (0.75; 0.71-0.78), particularly of using 3 or more courses (0.50, 0.46-0.55), and the adjusted odds of respiratory hospitalization were lower (0.69; 0.59-0.81).
Conclusion
Although symptomatic control and rescue bronchodilator use may be improved by the addition of a LABA to ICS, there may be a lower risk of severe exacerbations and hospitalizations from ICS dose increase.

Full text not available from this repository.

More information

e-pub ahead of print date: 5 November 2008
Published date: January 2009
Keywords: asthma, long-acting ?-agonist, inhaled corticosteroid, safety, inflammation, observational study
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 337296
URI: http://eprints.soton.ac.uk/id/eprint/337296
ISSN: 0091-6749
PURE UUID: f4269e25-5a04-4d45-a879-e7118f8ca34f

Catalogue record

Date deposited: 23 Apr 2012 11:40
Last modified: 18 Jul 2017 06:03

Export record

Altmetrics

Contributors

Author: M. Thomas
Author: J. von Ziegenweidt
Author: A. Lee
Author: D. Price

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×