A retrospective observational study comparing rescue medication use in children on combined versus separate long-acting  -agonists and corticosteroids

• Published in: Archives of disease in childhood 2010-10, Vol.95 (10), p.817-821
• Main Authors: Elkout, H., McLay, J. S., Simpson, C. R., Helms, P. J.
• Format: Article
• Language: English
• Subjects: Adrenergic beta agonists; Age; Asthma; Asthma in children; Childhood asthma; Corticoids; Corticosteroid drugs; Corticosteroids; Demographic aspects; Dosage and administration; Drug dosages; Drug therapy; Drug Use; Informatics; Information Science; Inhalers; Medical practices; Observational studies; Patient outcomes; Patients; Prescriptions; Primary care; Reference Groups; Steroids
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2009.179069

Background Data on the efficacy and safety of long-acting β2-agonists (LABA) in children are limited, and current guidelines recommend that LABA always be used with inhaled corticosteroids (ICS). Objective To compare asthma control, assessed by rescue medications use, in children prescribed LABA and ICS as a fixed-dose combination (LABA/ICS) or concurrently via separate inhalers (LABA+ICS). Methods Retrospective observational study of asthma medication prescribed to children aged 0-18 years registered with 40 primary care practices for the years 2002-6. Asthma control, reflected by requirement for oral corticosteroids (OCS) and/or six or more short-acting β2-agonist (SABA) canisters per year, was assessed for children prescribed LABA/ICS or LABA+ICS. Results 10 454 (8%) of all registered children received at least one prescription for asthma medication over the study period. Prescribing of LABA/ICS increased significantly, with a concomitant decrease in prescribing of LABA+ICS. Use of OCS increased by 60%, with the lowest use in children prescribed only SABA and highest use in those prescribed LABA. Children prescribed LABA/ICS were significantly less likely than those prescribed LABA+ICS to require OCS rescue therapy and or >6 SABA inhalers a year (OR 1.6; 95% CI 1.1 to 2.2; p=0.04 and OR 1.7; 95% CI 1.1 to 2.5; p=0.005, respectively, for the years 2005-6). Conclusions The results of this retrospective observational study suggest that children prescribed fixed-dose LABA-and-ICS combination devices achieve better asthma control, as reflected in reduced requirements for SABA and reduced courses of OCS than equivalent doses in separate devices.