dc.contributor.author | Israel, E | en_US |
dc.contributor.author | Roche, N | en_US |
dc.contributor.author | Martin, RJ | en_US |
dc.contributor.author | Colice, G | en_US |
dc.contributor.author | Dorinsky, PM | en_US |
dc.contributor.author | Postma, DS | en_US |
dc.contributor.author | Guilbert, TW | en_US |
dc.contributor.author | van Aalderen, WMC | en_US |
dc.contributor.author | Grigg, J | en_US |
dc.contributor.author | Hillyer, EV | en_US |
dc.contributor.author | Burden, A | en_US |
dc.contributor.author | von Ziegenweidt, J | en_US |
dc.contributor.author | Thomas, V | en_US |
dc.contributor.author | Price, DB | en_US |
dc.date.accessioned | 2015-07-09T15:21:01Z | |
dc.date.issued | 2015-06 | en_US |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/7885 | |
dc.description.abstract | RATIONALE: Guidelines advocate adding long-acting β-agonist (LABA) to inhaled corticosteroid as the preferred step-up therapy to increasing inhaled corticosteroid dose for patients with uncontrolled asthma on inhaled corticosteroid monotherapy. However, less than 5% of patients with asthma qualify for the randomized controlled trials on which guidelines are based. Thus, real-world data are needed to complement the results of randomized trials with narrow entry criteria. OBJECTIVES: To compare the effectiveness of stepping up asthma therapy with an increased dose of various types of inhaled corticosteroid as compared with add-on LABA. METHODS: We performed a historical matched cohort study using large primary care databases to compare asthma step-up therapy with small- and standard size-particle inhaled corticosteroid versus added LABA for patients 12-80 years old. As outcomes, we examined a composite of asthma control and rates of severe exacerbations. MEASUREMENTS AND MAIN RESULTS: The odds of asthma control and rates of severe exacerbations over one outcome year were comparable with increased inhaled corticosteroid dose versus added LABA. The adjusted odds ratios (95% confidence interval) for achieving asthma control with increased inhaled corticosteroid dose versus inhaled corticosteroid/LABA were 0.99 (0.88-1.12) for small-particle inhaled corticosteroid (n = 3,036 per cohort) and 0.85 (0.67-1.07) for standard size-particle inhaled corticosteroid (n = 809 per cohort). The adjusted rate ratios (95% confidence interval) for severe exacerbations, compared with inhaled corticosteroid/LABA combination inhaler, were 1.04 (0.91-1.20) and 1.18 (0.92-1.54), respectively. The results were not affected by smoking status. CONCLUSIONS: When applied to a broad primary care population, antiinflammatory therapy using increased doses of small- or standard size-particle inhaled corticosteroid is as effective as adding LABA, as measured by outcomes important to both patients and providers. Real-world populations and outcomes need to be taken into consideration when formulating treatment recommendations. | en_US |
dc.format.extent | 798 - 806 | en_US |
dc.language | eng | en_US |
dc.relation.ispartof | Ann Am Thorac Soc | en_US |
dc.subject | adrenergic β2-agonists | en_US |
dc.subject | antiasthmatic agents | en_US |
dc.subject | bronchodilator agents | en_US |
dc.subject | disease exacerbation | en_US |
dc.subject | glucocorticoids | en_US |
dc.subject | Administration, Inhalation | en_US |
dc.subject | Adrenergic beta-2 Receptor Agonists | en_US |
dc.subject | Adult | en_US |
dc.subject | Anti-Asthmatic Agents | en_US |
dc.subject | Asthma | en_US |
dc.subject | Cohort Studies | en_US |
dc.subject | Comparative Effectiveness Research | en_US |
dc.subject | Databases, Factual | en_US |
dc.subject | Delayed-Action Preparations | en_US |
dc.subject | Disease Progression | en_US |
dc.subject | Dose-Response Relationship, Drug | en_US |
dc.subject | Drug Therapy, Combination | en_US |
dc.subject | Female | en_US |
dc.subject | Glucocorticoids | en_US |
dc.subject | Humans | en_US |
dc.subject | Male | en_US |
dc.subject | Middle Aged | en_US |
dc.subject | Outcome Assessment (Health Care) | en_US |
dc.subject | United Kingdom | en_US |
dc.title | Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting β-Agonist for Step-Up Therapy in Asthma. | en_US |
dc.type | Article | |
dc.identifier.doi | 10.1513/AnnalsATS.201412-580OC | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/25756308 | en_US |
pubs.issue | 6 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 12 | en_US |