Better together or apart? LABA and ICS in childhood asthma.

Published Online; July 12, 2016

Approximately 10% of children with asthma have symptoms which do not respond to the first line preventer treatment with inhaled corticosteroids (ICS), and in this setting the addition of long acting beta agonists (LABA) by inhaler is recommended. The ICS and LABA can either be delivered as separate inhalers or together in a single fixed dose combination inhaler (FDC). International guidelines recommend that LABA should be delivered by FDC but this recommendation is based on little evidence. This study used routinely acquired primary care prescribing data to answer the question “how do asthma outcomes differ when children already on ICS are started on LABA either as a separate or FDC inhaler?”

Asthma prescribing data from two large primary care research databases were used. These data are based on 15% of the UK population. Children were included if they were: aged 5-12 years, diagnosed with asthma (or prescribed ICS), had LABA added to ICS treatment and their prescribing details were available for a continuous two year period. The main outcome was asthma control (as evidenced by the need for medicine which relieves asthma symptoms) and other outcomes including asthma exacerbation requiring oral corticosteroid treatment.

Children in whom LABA was added to ICS as either an FDC or separate inhaler were identified.  Using data collected in the year prior to LABA add-on, children were matched and compared based on prescription of a separate of FDC inhaler.  

Turner et al reported in The Journal of Allergy and Clinical Immunology: In Practice a study comparing asthma outcomes in 1330 started on FDC and 1330 started on separate LABA and ICS inhalers. The odds of achieving overall asthma control was higher by an average of 23% in the children who received a LABA as FDC compared with those started on a separate LABA inhaler. Children started on FDC on average required one fewer inhaler of asthma relieving medicine per year compared to those started on a separate LABA inhaler. The risk for an asthma exacerbation was 21% lower for those started on LABA as FDC compared to a separate LABA inhaler.   

These findings support current recommendations that LABA treatment in children with asthma should be delivered by FDC inhaler and not as a separate inhaler.

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

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