Current approaches to asthma management: assessing clinical and economic evidence

To review the consistency of scientific, clinical, and economic evidence related to dual-controller therapy with inhaled corticosteroids (ICS) and the inhaled long-acting beta2-agonist (LABA) salmeterol in treating patients whose asthma is not controlled with ICS alone.

This article is based on a presentation given by the author at a symposium entitled. Optimizing Clinical and Economic Outcomes in Asthma Management. at the Academy of Managed Care Pharmacy.s 2000 Educational Conference in San Diego, California, on October 5, 2000.

Scientific research supports the complementary effect of ICSs and LABAs in preventing bronchoconstriction and inflammation. For patients using an ICS and still exhibiting symptoms, randomized clinical trials (RCTs) have shown that adding salmeterol resulted in greater clinical efficacy and fewer asthma exacerbations than either at least doubling the dose of ICS or adding a leukotriene modifier. Two studies comparing the clinical efficacy of adding either a LABA or leukotriene modifier to low-dose ICS therapy favored the former combination. The addition of a LABA has allowed a reduction of the steroid dose in patients with stable asthma without a decline in short-term asthma control. Whether the ICS dose reduction can be maintained long term without any deleterious effects remains unknown. While RCTs are useful for determining safety and clinical efficacy, their results may have limited applicability in general clinical practice. Retrospective cohort analysis using large administrative data sets from managed health plans is an alternative method for determining the economic outcomes of common dual-controller regimens. The economic benefits of ICS and salmeterol in 5 retrospective cohort analyses mirror the clinical results of the RCTs.