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

David Price, N Roche, J C Virchow, A Burden, M Ali, A Chisholm, Amanda J. Lee, EV Hillyer, J von Ziegenweidt

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58 Citations (Scopus)


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 ß2-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.
Original languageEnglish
Pages (from-to)1457-1466
Number of pages10
JournalRespiratory Medicine
Issue number10
Early online date25 May 2011
Publication statusPublished - Oct 2011


  • asthma
  • combination therapy
  • inhaled corticosteroids
  • inhaler device
  • long-acting ß2-agonist
  • primary care


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