TY  - BOOK
AU  - Colice, Gene L
TI  - Increased Dose of Inhaled Corticosteroid versus Add-On Long-acting beta-Agonist for Step-Up Therapy in Asthma
SN  - 2325-6621
PY  - 2015///
KW  - *Adrenergic beta-2 Receptor Agonists
KW  - *Asthma/dt [Drug Therapy]
KW  - *Glucocorticoids
KW  - Administration, Inhalation
KW  - Adrenergic beta-2 Receptor Agonists/ad [Administration & Dosage]
KW  - Adrenergic beta-2 Receptor Agonists/ae [Adverse Effects]
KW  - Adult
KW  - Anti-Asthmatic Agents/ad [Administration & Dosage]
KW  - Anti-Asthmatic Agents/ae [Adverse Effects]
KW  - Asthma/ep [Epidemiology]
KW  - Asthma/pp [Physiopathology]
KW  - Cohort Studies
KW  - Comparative Effectiveness Research
KW  - Databases, Factual
KW  - Delayed-Action Preparations
KW  - Disease Progression
KW  - Dose-Response Relationship, Drug
KW  - Drug Therapy, Combination/mt [Methods]
KW  - Female
KW  - Glucocorticoids/ad [Administration & Dosage]
KW  - Glucocorticoids/ae [Adverse Effects]
KW  - Great Britain/ep [Epidemiology]
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Outcome Assessment (Health Care)
KW  - MedStar Washington Hospital Center
KW  - Medicine/Pulmonary-Critical Care
KW  - Journal Article
KW  - Research Support, Non-U.S. Gov't
N2  - CONCLUSIONS: When applied to a broad primary care population, antiinflammatory therapy using increased doses of small- or standard size-particle inhaled corticosteroid is as effective as adding LABA, as measured by outcomes important to both patients and providers. Real-world populations and outcomes need to be taken into consideration when formulating treatment recommendations; MEASUREMENTS AND MAIN RESULTS: The odds of asthma control and rates of severe exacerbations over one outcome year were comparable with increased inhaled corticosteroid dose versus added LABA. The adjusted odds ratios (95% confidence interval) for achieving asthma control with increased inhaled corticosteroid dose versus inhaled corticosteroid/LABA were 0.99 (0.88-1.12) for small-particle inhaled corticosteroid (n = 3,036 per cohort) and 0.85 (0.67-1.07) for standard size-particle inhaled corticosteroid (n = 809 per cohort). The adjusted rate ratios (95% confidence interval) for severe exacerbations, compared with inhaled corticosteroid/LABA combination inhaler, were 1.04 (0.91-1.20) and 1.18 (0.92-1.54), respectively. The results were not affected by smoking status; METHODS: We performed a historical matched cohort study using large primary care databases to compare asthma step-up therapy with small- and standard size-particle inhaled corticosteroid versus added LABA for patients 12-80 years old. As outcomes, we examined a composite of asthma control and rates of severe exacerbations; OBJECTIVES: To compare the effectiveness of stepping up asthma therapy with an increased dose of various types of inhaled corticosteroid as compared with add-on LABA; RATIONALE: Guidelines advocate adding long-acting beta-agonist (LABA) to inhaled corticosteroid as the preferred step-up therapy to increasing inhaled corticosteroid dose for patients with uncontrolled asthma on inhaled corticosteroid monotherapy. However, less than 5% of patients with asthma qualify for the randomized controlled trials on which guidelines are based. Thus, real-world data are needed to complement the results of randomized trials with narrow entry criteria
ER  -