Session 3.2: Late Breaking Abstract Session
AB027. Long-acting beta-agonist in combination or separate inhaler as step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids
Steve Turner1, Kathryn Richardson2, Clare Murray3, Mike Thomas4, Elizabeth V. Hillyer2, Anne Burden2, David B. Price2,5; on behalf of the Respiratory Effectiveness Group
1Department of Child Health, University of Aberdeen, UK; 2Research in Real-life Ltd, Cambridge, UK; 3Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester and University Hospital of South Manchester, NHS Foundation Trust, UK; 4Primary Care and Population Sciences, University of Southampton, UK. NIHR Wessex CLAHRC and NIHR Southampton Biomedical Research Unit; 5Academic Primary Care, University of Aberdeen, UK
Background: Adding a long-acting β2-agonist (LABA) to inhaled corticosteroids (ICS) using a fixed-dose combination (FDC) inhaler containing ICS and LABA is the UK guideline-recommended step-up option for children aged >4 years with uncontrolled asthma on ICS monotherapy. The evidence of benefit of FDC inhalers over adding a separate LABA inhaler to ICS therapy is limited. Our aim was to compare outcomes for FDCversusseparate LABA + ICS inhalers for children by analyzing routinely-acquired clinical and prescribing data.
Methods: This matched cohort study used large UK primary care databases to study children prescribed their first step-up from ICS monotherapy at 5–12 years of age as add-on LABA, either via separate LABA inhaler or FDC inhaler. A baseline year was examined to characterize patients and identify potential confounders; outcomes were examined during the subsequent year. The primary outcome was overall asthma control.
Results: After matching, there were 1,330 children in each cohort [mean age (SD) 9 (2) years; 59% male]. All measures of asthma exacerbations and control improved during the outcome year in both cohorts. In the separate ICS + LABA cohort, the odds of failing to achieve overall asthma control were higher [adjusted odds ratio 1.30, (95% CI, 1.10–1.52) P=0.002] compared with the FDC cohort. Acute respiratory events were more frequent [adjusted rate ratio 1.21, (1.04–1.39) P=0.012] in the ICS + LABA compared to the FDC cohort.
Conclusions: These results support current recommendations that add-on LABA therapy for children should be administered as an FDC and not as separate inhaler.
Keywords: Long-acting beta-agonist (LABA); asthma; inhaled corticosteroids (ICS); children; step-up therapy
doi: 10.21037/jtd.2016.s027
Cite this abstract as: Turner S, Richardson K, Murray C, Thomas M, Hillyer EV, Burden A, Price DB; on behalf of the Respiratory Effectiveness Group. Long-acting beta-agonist in combination or separate inhaler as step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids. J Thorac Dis 2016;8(Suppl 5):AB027. doi: 10.21037/jtd.2016.s027
