Appropriate use of inhaled corticosteroid and long-acting beta(2)-adrenergic agonist combination therapy among asthma patients in a US commercially insured population

Curr Med Res Opin. 2009 Sep;25(9):2251-8. doi: 10.1185/03007990903155915.


Objective: To examine health care utilization measures indicating which asthma patients are appropriate for inhaled corticosteroid and long-acting beta(2)-adrenergic agonist (ICS/LABA) therapy and determine whether two ICS/LABA therapies were initiated in accordance with guidelines.

Research design and methods: A retrospective cohort study of commercially insured asthma patients aged > or =12 years that initiated fluticasone propionate/salmeterol (FSC) or budesonide/formoterol fumarate dihydrate (BFC) combination therapy in 2007 was conducted. Use was considered appropriate if patients met any of the following during a 1-year period before ICS/LABA initiation: ICS or leukotriene receptor antagonist (LTRA) use; an asthma-related emergency department (ED) visit or hospitalization; > or =2 oral corticosteroids (OCS) courses; or > or =6 short-acting beta(2)-adrenergic agonist (SABA) canisters. Multivariate logistic regression was used to assess factors associated with appropriate ICS/LABA use. Certain limitations inherent to the use of claims data for research apply to this study.

Results: Of 24,231 patients who initiated ICS/LABA therapy, 993 received BFC and 23,238 received FSC. Among all patients, 37.6% met > or =1 criteria for appropriate use. However, compared with FSC users, BFC users had a significantly higher likelihood of meeting > or =1 of these criteria (odds ratio, 2.01; 95% CI, 1.76-2.30; p < 0.001), and a higher proportion of BFC than FSC patients met 4 of the 5 appropriate use criteria. In total, 58.4% of BFC patients versus 36.7% of FSC patients met > or =1 criteria for appropriate use. Other factors associated with appropriate use included age, region, Charlson comorbidity score, number of medications, and prescriber specialty.

Conclusion: Fewer than half of all patients fulfilled the specified criteria for being appropriate for ICS/LABA therapy. However, a significantly higher proportion of BFC than FSC users met the criteria for appropriate use of ICS/LABA therapy. These results may suggest a need for improved physician awareness of consensus guidelines for the initiation of ICS/LABA therapy.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / economics
  • Adrenergic Agonists / administration & dosage*
  • Adrenergic Agonists / economics
  • Adrenergic beta-2 Receptor Agonists*
  • Adult
  • Aged
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / economics
  • Asthma / drug therapy*
  • Asthma / economics
  • Child
  • Commerce
  • Drug Therapy, Combination
  • Drug Utilization* / economics
  • Drug Utilization* / statistics & numerical data
  • Female
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Male
  • Middle Aged
  • Population
  • Retrospective Studies
  • United States
  • Young Adult


  • Adrenal Cortex Hormones
  • Adrenergic Agonists
  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents