title: Add-on LABA in a separate inhaler as asthma step-up therapyversusincreased dose of ICS or ICS/LABA combination inhaler.
abstract: Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effective, and whether LABA should be administered by separate or combination inhalers. This historical, matched cohort study compared asthma-related outcomes for patients (aged 12-80 years) prescribed step-up therapy as a ≥50% extrafine ICS dose increase or add-on LABA,viaeither a separate inhaler or a fine-particle ICS/LABA fixed-dose combination (FDC) inhaler. Risk-domain asthma control was the primary end-point in comparisons of cohorts matched for asthma severity and control during the baseline year. After 1:2 cohort matching, the increased extrafine ICSversusseparate ICS+LABA cohorts included 3232 and 6464 patients, respectively, and the fine-particle ICS/LABA FDCversusseparate ICS+LABA cohorts included 7529 and 15 058 patients, respectively (overall mean age 42 years; 61-62% females). Over one outcome year, adjusted OR (95% CI) for achieving asthma control were 1.25 (1.13-1.38) for increased ICSversusseparate ICS+LABA and 1.06 (1.05-1.09) for ICS/LABA FDCversusseparate ICS+LABA. For patients with asthma, increased dose of extrafine-particle ICS, or add-on LABAviaICS/LABA combination inhaler, is associated with significantly better outcomes than ICS+LABAviaseparate inhalers.
authors.affiliation: Academic Primary Care, University of Aberdeen, Aberdeen, UK; Observational and Pragmatic Research Institute, Singapore, Singapore.
authors.forename: David B
authors.initials: DB
authors.lastname: Price
authors.affiliation: Washington Hospital Center and George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Colice
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.affiliation: University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.affiliation: Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.affiliation: Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: Willem M C
authors.initials: WM
authors.lastname: van Aalderen
authors.affiliation: Blizard Institute, Queen Mary University of London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grigg
authors.affiliation: Observational and Pragmatic Research Institute, Singapore, Singapore.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Hillyer
authors.affiliation: Observational and Pragmatic Research Institute, Singapore, Singapore.
authors.forename: Victoria
authors.initials: V
authors.lastname: Thomas
authors.affiliation: National Jewish Health and the University of Colorado Denver, Denver, CO, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin