Published Online: July 25, 2014
The most commonly used medications for asthma are inhaled corticosteroids, leukotriene receptor antagonists, and inhaled corticosteroid/long acting beta agonist combination therapy. Studies have found that inhaled corticosteroids have greater efficacy than leukotriene receptor antagonists to prevent exacerbations of childhood asthma under controlled circumstances. However, few studies have compared the effectiveness of these controller medication regimens under real-life conditions.
In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Wu and colleagues set out to determine the likelihood of asthma exacerbations after initiation of controller medications among children with asthma—under real-life conditions. Using electronic data from TennCare Medicaid and five large health plans (Harvard Pilgrim Health Care, HealthPartners, Kaiser Permanente Northern California, Kaiser Permanente Northwest, and Kaiser Permanente Georgia), Wu and colleagues studied a total of 26,191 children ages 4-17 years with uncontrolled asthma. The main outcome measures were asthma-related emergency department visits or hospitalizations, or oral corticosteroid use in the year after filling a controller medication.
Wu and colleagues found that overall adherence to controller medications was low. In patients with allergic rhinitis, subjects in TennCare Medicaid who were treated with leukotriene antagonists were less likely to experience emergency department visits compared to subjects treated with inhaled corticosteroids. For all other groups, the risk of emergency department visits, hospitalizations, and oral corticosteroids did not differ between children who initiated leukotriene antagonists and inhaled corticosteroids. These findings may be explainable by leukotriene antagonists having similar effectiveness as inhaled corticosteroids in real-life usage, by residual confounding by indication, or other unmeasured factors.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.