The relationship between combination inhaled corticosteroid and long-acting β-agonist use and severe asthma exacerbations in a diverse population - 28/04/12
, Edward L. Peterson, PhD a, Brian K. Ahmedani, PhD c, Richard K. Severson, PhD b, Julie Gleason-Comstock, PhD, MCHES d, L. Keoki Williams, MD, MPH c, e
Corresponding author: Karen E. Wells, MPH, Department of Public Health Sciences, Henry Ford Hospital, Henry Ford Health System, 1 Ford Place, 5C, Detroit, MI 48202.Abstract |
Background |
Safety concerns surround the use of long-acting β-agonists (LABAs) for the treatment of asthma, even in combination with inhaled corticosteroids (ICSs) and particularly in high-risk subgroups.
Objective |
To estimate the effect of ICS therapy and fixed-dose ICS/LABA combination therapy on severe asthma exacerbations in a racially diverse population.
Methods |
ICS and ICS/LABA exposure was estimated from pharmacy data for patients with asthma aged 12 to 56 years who were members of a large health maintenance organization. ICS and ICS/LABA use was estimated for each day of follow-up to create a moving window of exposure. Proportional hazard models were used to assess the relationship between ICS and ICS/LABA combination therapy and severe asthma exacerbations (ie, use of oral corticosteroids, asthma-related emergency department visit, or asthma-related hospitalization).
Results |
Among the 1828 patients who met the inclusion criteria, 37% were African American, 46% were treated with ICS therapy alone, and 54% were treated with an ICS/LABA combination. Models assessing the risk of severe asthma exacerbations among individuals using ICS treatment alone and ICS/LABA combination therapy suggested that the overall protective effect was as good or better for ICS/LABA combination therapy when compared with ICS treatment alone (hazard ratio, 0.65 vs 0.72, respectively). Analyses in several subgroups, including African American patients, showed a similar statistically significant protective association for combination therapy.
Conclusion |
Treatment with ICS/LABA fixed-dose combination therapy appeared to perform as well as or better than ICS treatment alone in reducing severe asthma exacerbations; this included multiple high-risk subgroups.
Le texte complet de cet article est disponible en PDF.Key words : Long-acting β-agonist, inhaled corticosteroid, severe asthma exacerbation, safety, racially and ethnically diverse population, observational study
Abbreviations used : FDA, HR, ICS, LABA, OCS, SABA
Plan
| This work was supported by grants from the Fund for Henry Ford Hospital, the American Asthma Foundation, the National Institute of Allergy and Infectious Diseases (grant nos. R01AI079139 and R01AI061774), the National Heart, Lung, and Blood Institute (grant no. R01HL079055), and the National Institute of Diabetes and Digestive and Kidney Diseases (grant no. R01DK064695), National Institutes of Health. This work represents a partial requirement for a Masters of Public Health degree at the Department of Family Medicine and Public Health Sciences, Wayne State University for Karen E. Wells. |
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| Disclosure of potential conflict of interest: L. K. Williams has received research support from the National Institutes of Health (National Institute of Allergy and Infectious Diseases, National Heart, Lung, and Blood Institute, and National Institute of Diabetes and Digestive and Kidney Diseases) and the American Asthma Foundation. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 129 - N° 5
P. 1274 - mai 2012 Retour au numéro
Article précédent
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