Adherence and persistence with fluticasone propionate/salmeterol combination therapy

J Allergy Clin Immunol. 2006 Oct;118(4):899-904. doi: 10.1016/j.jaci.2006.07.002. Epub 2006 Sep 8.


Background: Pharmacy database medication refill studies provide a panoramic view of medication-taking behavior in patients nationally.

Objective: To investigate fluticasone propionate/salmeterol combination (FSC) adherence, including the factors associated with refill adherence in a large national pharmacy database.

Methods: Adherence and persistence were documented for 12 months from date of initial FSC prescription in 5504 patients who filled their medication at a nationwide pharmacy chain.

Results: On average, patients filled enough medication to cover 22.2% of days. More than half the patients filled a 30-day prescription only once over the 1-year interval. Higher adherence levels were associated with being male, being older than 35 years, having a comorbid disorder, a having a copay of 1.01 dollar to 10 dollars, previous beta2-agonist use, and a prescription for higher-dose FSC.

Conclusion: This pharmacy database study portrays medication adherence levels to be considerably lower than those reported in most clinical trials, suggests that most adults taking FSC obtain a single fill before abandoning their controller medication, and indicates a need for a reappraisal of current treatment guidelines and educational strategies for both providers and patients.

Clinical implications: For many patients, filling of a controller medication is markedly discrepant with practice guidelines. Reappraisal of both the guidelines and strategies to implement them is in order.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Androstadienes / therapeutic use*
  • Asthma / drug therapy*
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • Fluticasone
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Retrospective Studies
  • Salmeterol Xinafoate
  • Sex Factors


  • Androstadienes
  • Bronchodilator Agents
  • Salmeterol Xinafoate
  • Fluticasone
  • Albuterol