Treatment choices influence rescue medication use in asthma

In patients with poor asthma control, switching from fluticasone propionate (FP) monotherapy to inhaled corticosteroid (ICS) plus a long-acting beta-agonist (LABA) combination therapy may help improve symptom control and reduce the use of reliever or rescue medications, according to a study.

“Majority of the patients tend to overuse their reliever medications, especially in the mild-to-moderate segment of patients. It's also well understood that this could be a factor of poor asthma control or lack of control of the underlying airway inflammation,” said one of the study authors Dr Anurita Majumdar of GSK, Global Classic and Established Medicines, Singapore, Singapore.

What is less understood or researched is the impact of baseline characteristics or traits or predictive traits of such patients in terms of their usage of reliever medications, Majumdar continued. For example, do these traits have an impact and if yes, what kind of impact and would that help physicians in planning the treatment better?

To quantify the effects of inter-individual differences in baseline characteristics and maintenance treatment choices on the use of reliever or rescue medications, Majumdar and colleagues used data from five clinical trials involving a total of 5,524 adult patients with moderate or severe asthma. The patients had received treatment for at least 6 months, had data on overnight reliever medication use, and had available asthma symptom score data as assessed using the Asthma Control Questionnaire (ACQ)-5.

A Poisson model that included baseline characteristics from the pooled patient population was used to simulate the average 24-hour rescue medication puffs over time during a 12-month period.

Results showed that worse asthma control (higher ACQ-5), longer disease duration, continued smoking, and obesity were all associated with higher predicted reliever or rescue medication use (p<0.001).

In a not-in-trial scenario where all the simulated patients were started on FP monotherapy, those with poor or not well controlled asthma at 3 months were switched to either a higher dose of FP monotherapy or ICS/LABA combination therapy.

“What we clearly saw was that stepping up treatment to ICS/LABA reduced the use of rescue medication (p<0.001),” Majumdar said. “Patients who remained on FP monotherapy had higher rescue medication use than those who switched to ICS/LABA.”

In conclusion, Majumdar acknowledged that asthma is a heterogeneous condition with a complex interplay of baseline patient characteristics which impact the use of rescue medication.

“This of course is a clinical modelling simulation study and hence needs to be understood more in a real-life situation to confirm the findings,” she added.