Acute care among asthma patients using budesonide/formoterol or fluticasone propionate/salmeterol

The combination of inhaled corticosteroids and long-acting inhaled beta(2)-adrenergic-agonists has become the standard therapy for many patients with moderate to severe persistent asthma. Whether the differences between budesonide/formoterol and fluticasone/salmeterol translate into differences in treatment outcomes in a real life setting is unknown.

This study compared the use of healthcare services between new users of budesonide/formoterol and fluticasone/salmeterol in a single inhaler between 2002 and 2004.

A 12-month population-based retrospective cohort study using administrative health care databases was conducted. Asthma patients 16-65 years of age using budesonide/formoterol were matched according to age and markers of asthma severity to patients using fluticasone/salmeterol. The rate of emergency department (ED) visits for asthma, hospitalizations for asthma, claims for oral corticosteroids, and visits to a respiratory specialist were compared between the two groups using Poisson regression models. The mean number of doses of short-acting beta(2)-adrenergic-agonists (SABA) per week was compared between the two groups using a linear regression model.

Users of budesonide/formoterol were found to be less likely to have an ED visit for asthma (adjusted RR=0.72; 95% CI: 0.54-0.96), a hospitalization for asthma (adjusted RR=0.50; 95% CI: 0.25-0.99), a claim for oral corticosteroids (adjusted RR=0.83; 95% CI: 0.72-0.95), and use SABA (adjusted mean difference=-1.1 dose per week; 95% CI: -1.7; -0.5) than patients treated with fluticasone/salmeterol.

Our study has found that subjects initiating ICS/LABA treatment with budesonide/formoterol had better outcomes than those initiating treatment with fluticasone/salmeterol.