title: Retrospective comparison of early versus late treatment with fluticasone propionate/salmeterol after an asthma exacerbation.
abstract: BACKGROUND
  The benefits of inhaled corticosteroids in asthma are well established. Early use of inhaled anti-inflammatories following and exacerbation could be beneficial.
  
  
  METHODS
  A retrospective observational cohort study compared the risk of asthma-related exacerbations [hospitalization, emergency department visit, and/or treatment with systemic corticosteroid] in patients receiving treatment with fluticasone propionate/salmeterol in a single inhaler (FSC) within 90 days following an initial asthma-related exacerbation (early treatment) versus patients receiving the treatment subsequently (late treatment). Data were from a large health insurance claims database spanning from January 1998 to April 2008. Subjects included patients with ≥1 prescription for FSC ≤ 1 year after first asthma-related exacerbation. Patients with early treatment were matched to those with late treatment by propensity score and compared in terms of healthcare utilization and costs after initiation of FSC.
  
  
  RESULTS
  A total of 14,861 patients met study inclusion criteria, including 10,793 early and 4068 late treatment patients. After matching, 3555 pairs were well matched on all pretreatment characteristics and duration of follow-up (mean 722 vs. 717 days, p = .634). Early versus late treatment was associated with longer time to first asthma-related exacerbation (hazard ratio = 0.82, 95% CI 0.75-0.88, p < .001), fewer short-acting β-agonists prescriptions (3.3 vs. 3.6, p = .031), higher outpatient yearly per patient pharmacy costs ($1320 vs. $1163, p = .008), and lower yearly per patient asthma-related emergency department visit costs ($80 vs. $105, p = .032). Total yearly per patient asthma-related costs were similar ($2197 vs. $2064, p = .203).
  
  
  CONCLUSIONS
  Earlier use of FSC following an asthma exacerbation was associated with reduced risk of future asthma-related exacerbation and lower use of rescue medications.
authors.affiliation: Policy Analysis Inc. (PAI) , Brookline, MA, USA.
authors.forename: May
authors.initials: M
authors.lastname: Hagiwara
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Delea
authors.forename: Richard H
authors.initials: RH
authors.lastname: Stanford
mesh_terms: D000293:Adolescent; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D000068299:Salmeterol Xinafoate; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D004338:Drug Combinations; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol