Device type and real-world effectiveness of asthma combination therapy: an observational study

Respir Med. 2011 Oct;105(10):1457-66. doi: 10.1016/j.rmed.2011.04.010. Epub 2011 May 25.


Background: Selection of inhaler device type appears to influence real-world effectiveness of inhaled corticosteroids (ICS), but data are lacking on the role of inhaler device in ICS and long-acting β2-agonist (LABA) combination therapy for asthma.

Methods: This retrospective matched cohort study compared 1-year asthma outcomes for UK patients initiating fixed-dose combination (FDC) fluticasone-salmeterol delivered by pressurised metered-dose inhaler (pMDI) versus dry powder inhaler (DPI). Patients with asthma aged 4-80 years receiving a first prescription for FDC fluticasone-salmeterol by pMDI or DPI were matched on baseline demographic and asthma severity measures. Co-primary outcomes were asthma control (a composite measure comprising no recorded hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory infection) and exacerbation rate.

Results: Compared with the DPI cohort (n = 1567), patients in the pMDI cohort (n = 1567) had significantly greater odds of achieving asthma control during the outcome year (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.01 to 1.40). Exacerbation rate was lower but not significantly in the pMDI cohort (adjusted rate ratio for pMDI cohort, 0.82; 95% CI 0.66 to 1.00). The odds of treatment success (defined as no exacerbations and no change in asthma therapy) was significantly greater in the pMDI cohort (OR 1.23; 95% CI, 1.07 to 1.42).

Conclusions: For UK primary care patients, pMDIs appear to achieve better asthma control outcomes than DPIs for delivery of FDC fluticasone-salmeterol. Pragmatic trials are needed to further investigate real-world outcomes with different inhaler devices for combination therapy.

Publication types

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

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Albuterol / administration & dosage
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Androstadienes / administration & dosage
  • Androstadienes / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / epidemiology
  • Asthma / physiopathology
  • Child
  • Child, Preschool
  • Disease Progression*
  • Drug Combinations
  • Drug Therapy, Combination
  • Dry Powder Inhalers*
  • Female
  • Fluticasone-Salmeterol Drug Combination
  • Glucocorticoids / administration & dosage
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Metered Dose Inhalers*
  • Middle Aged
  • Research Design
  • Retrospective Studies
  • Treatment Outcome
  • United Kingdom / epidemiology
  • Young Adult


  • Androstadienes
  • Drug Combinations
  • Fluticasone-Salmeterol Drug Combination
  • Glucocorticoids
  • Albuterol