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Association of Inhaled Corticosteroid and Long-Acting Beta Agonist Combination Versus Inhaled Corticosteroid Only

Javeria Khalid1, Hua Chen1,2, Harold J Farber3,4

  • 1Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA.

Pediatric Pulmonology
|May 21, 2026
PubMed

Insights

Children with asthma using ICS-LABA inhalers showed better adherence but higher healthcare use than ICS-only users. Adherence remains low overall, suggesting potential unmeasured factors influence outcomes.

Area of Science:

  • Pediatric Pulmonology
  • Real-World Evidence
  • Health Services Research

Background:

  • Asthma is a common chronic condition in US children.
  • Limited real-world data exists on medication adherence and healthcare utilization in underserved pediatric populations.
  • This study focuses on Medicaid-enrolled children.

Purpose of the Study:

  • Evaluate medication adherence and persistence for inhaled corticosteroids (ICS) versus ICS-long-acting beta-agonist (ICS-LABA) inhalers in pediatric asthma patients.
  • Assess asthma-related healthcare utilization in these groups.

Main Methods:

  • Retrospective cohort study using Texas Children's Health Plan claims data (2016-2019).
  • Included children aged 4-17 with asthma diagnoses and ≥1 ICS or ICS-LABA prescription.
  • Adherence measured by Proportion of Days Covered (PDC) ≥50% (sensitivity analysis used PDC ≥80%). Persistence defined as continuous therapy without a 60-day gap.
  • Multivariable logistic regression used to analyze outcomes.

Main Results:

  • ICS-LABA users demonstrated higher adherence (PDC ≥50%: aOR=1.35) and persistence (aOR=1.86) compared to ICS-only users.
  • Despite better adherence, ICS-LABA users had increased asthma-related emergency department (ED) visits (aOR=1.81) and hospitalizations (aOR=2.55).
  • These utilization differences persisted even after adjusting for adherence.

Conclusions:

  • Inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) therapy was associated with greater adherence than ICS-only therapy in pediatric asthma patients.
  • Low adherence rates were observed in both treatment groups.
  • Increased healthcare utilization in the ICS-LABA group may indicate higher underlying disease severity.
Abstract

Keywords:
ICSICS‐LABAMedicaidadherenceinhaled corticosteroidslong‐acting β2 agonistpediatric asthma

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