title: Characterization of long-acting beta₂-adrenergic agonists utilization in asthma patients.
abstract: OBJECTIVE
  Because of the serious safety risks, Food and Drug Administration (FDA) has recommended that long-acting beta₂-adrenergic agonists (LABAs) be reserved for patients whose asthma cannot be adequately managed with asthma control medication. The objective of the study is to assess prescribing patterns for LABAs prior to the FDA's drug safety communication issued on 2 June 2010.
  
  
  METHODS
  Data were extracted from IMS Health Plan Claims database for asthma patients who had a new LABA therapy during 2005-2009. The proportion of LABA incident episodes preceded by inhaled corticosteroid (ICS) or leukotriene receptor antagonists (LTRAs) was examined. The medication-concurrent ratio (MCR), defined as the ratio of overlapping therapy days of single-ingredient (SI) LABAs and non-LABA products to the total days of SI LABAs, was calculated. Four criteria were used to estimate poorly controlled asthma prior to LABA initiation.
  
  
  RESULTS
  Of the 228 047 asthma patients, fixed-dose combination (FDC) LABAs were used by the majority of patients (96%). Prior use of ICS or LTRAs was observed in 64% and 31% of SI and FDC LABA incident episodes, respectively. The median MCR for SI LABAs was 62%. Approximately half of the patients met at least one criterion for poorly controlled asthma prior to LABA use.
  
  
  CONCLUSIONS
  Substantial proportion of patients was prescribed LABAs without prior use of ICS or LTRAs, or other indicators of poor asthma control. These findings suggest that asthma guidelines were not entirely followed in clinical practice during the study period.
authors.affiliation: Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD 20993, USA.
authors.forename: Sigal
authors.initials: S
authors.lastname: Kaplan
authors.forename: Esther H
authors.initials: EH
authors.lastname: Zhou
authors.forename: Solomon
authors.initials: S
authors.lastname: Iyasu
mesh_terms: D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D004338:Drug Combinations; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D003692:Delayed-Action Preparations; D004338:Drug Combinations