Ecologic analysis of asthma-related events and dispensing of inhaled corticosteroid- and salmeterol-containing products

Ann Allergy Asthma Immunol. 2008 Jun;100(6):558-65. doi: 10.1016/S1081-1206(10)60048-8.


Background: An association between salmeterol use and serious asthma episodes or asthma-related mortality has been noted in 2 clinical trials; however, a causal relationship has not been established. To date, observational studies have not replicated this finding.

Objective: To examine the relationship between number of prescriptions dispensed of salmeterol-containing products and inhaled corticosteroid (ICS)-containing products and the rates of asthma-related hospitalizations and mortality in the United States.

Methods: In this ecologic study, annual age-adjusted rates of asthma-related hospitalization and asthma-related mortality from US population-based sources were graphed alongside annual number of prescriptions dispensed of salmeterol- and ICS-containing products by year from 1991 to 2004. We computed the Spearman rank correlations between number of prescriptions dispensed and serious events (asthma-related hospitalization rate, number of hospitalizations, asthma-related mortality rate, and number of asthma deaths).

Results: During more than 14 years, while number of prescriptions dispensed of salmeterol-containing and ICS-containing products increased, age-adjusted asthma-related mortality rates declined and asthma-related hospitalization rates remained relatively stable. The number of asthma-related deaths has decreased steadily since the mid-1990s.

Conclusion: This study provides population-level evidence that asthma-related death rates declined and asthma-related hospitalization rates remained relatively constant for more than 14 years during a period of improvements in asthma management per treatment guidelines, including increased use of maintenance medications, such as ICSs and salmeterol.

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Androstadienes / administration & dosage
  • Androstadienes / therapeutic use
  • Asthma / drug therapy*
  • Asthma / mortality
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use
  • Centers for Disease Control and Prevention, U.S.
  • Drug Combinations
  • Drug Utilization / statistics & numerical data
  • Drug Utilization / trends
  • Fluticasone-Salmeterol Drug Combination
  • Health Care Surveys
  • Hospitalization / statistics & numerical data*
  • Humans
  • National Center for Health Statistics, U.S.
  • Salmeterol Xinafoate
  • Survival Rate
  • United States
  • Vital Statistics


  • Adrenal Cortex Hormones
  • Androstadienes
  • Bronchodilator Agents
  • Drug Combinations
  • Fluticasone-Salmeterol Drug Combination
  • Salmeterol Xinafoate
  • Albuterol