Exacerbation rates of asthma patients initiating ICS/LABA combination therapies


Published Online: October 3, 2014

Asthma management imposes heavy demands on available healthcare resources and patients. Real-world comparative effectiveness of two commonly prescribed therapies (BFC and FSC) for the treatment of asthma has been studied in Canada and Germany and suggested that patients who initiate BFC therapy may have a lower asthma exacerbation rate compared to those initiating FSC. Comparative effectiveness of BFC and FSC therapy on asthma exacerbation has not been assessed in a similar real-world setting in the United States (US).

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Tunceli et al. evaluate the real world effectiveness of ICS/LABA combination therapies by comparing asthma exacerbation rates and healthcare resource utilization over a one-year period following initiation of BFC and FSC with devices and indications approved in the US.

The authors used large nationally representative administrative claims database to identify asthma patients aged 12-64 years old in the US. Patients in their study were assigned to BFC or FSC cohorts based on their first prescription fill, were matched using propensity scores based on demographic and clinical characteristics, and were followed for 12 months following therapy initiation. An exacerbation was defined as an asthma-related hospitalization, emergency department (ED) visit, and/or an oral corticosteroid (OCS) prescription fill. The rate of asthma exacerbation was calculated as the total number of asthma exacerbations during the follow-up period divided by the total follow-up time in person years. All-cause and asthma-related healthcare resource utilization during the 12-month post-index period were compared between cohorts.  

Among their population, 6,086 asthma patients initiating BFC or FSC were matched. Patients in each cohort had a mean (±SD) age of 40(±14.8) years, and 63.5% were female. During the 12 months following the initiation of the therapy, the BFC cohort had a lower unadjusted asthma exacerbation rate compared to the FSC cohort, 0.83 versus 0.89, respectively. Covariate adjusted exacerbation rates during the follow-up period were lower for the BFC cohort compared to FSC cohort (0.85 vs. 0.93, rate ratio= 0.92, 95% CI= [0.85, 0.99]). The BFC cohort had fewer OCS fills and fewer asthma-related ED visits, but comparable rates of asthma-related hospitalization.

In this first US comparative effectiveness study of BFC vs. FSC combination therapies for asthma in a real world population, Tunceli et al found lower rates of asthma exacerbation in the BFC cohort compared to the FSC cohort due to lower rates of OCS use and asthma-related ED visits.   


The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter