A retrospective study of the use of fluticasone propionate/salmeterol combination as initial asthma controller therapy in a commercially insured population

Abstract

Background: Asthma management guidelines state that a low-dose inhaled corticosteroid (ICS) is the preferred treatment for mild persistent asthma and that coadministration of a long-acting β2-agonist (LABA) should be reserved for patients whose asthma is uncontrolled by single-entity ICS. However, it appears that many patients in the United States with mild persistent asthma are initially treated with combinations of fluticasone propionate/salmeterol (FPS).Objective: The aim of this study was to examine whether use of FPS was consistent with asthma management guidelines.Methods: A commercial insurance database was analyzed retrospectively to identify patients aged 12 to 62 years who had ≥1 pharmacy claim for FPS between October 1, 2004, and September 30, 2006. An index date corresponding to the date of the first FPS pharmacy claim was assigned to each patient. Medical and pharmacy claims data were analyzed for the 365-day period before the index date (preindex period). The severity of patients' asthma was inferred from their history of claims. Patients were identified as having more severe asthma if, during the preindex period, they either received >365 doses of short-acting β2-agonists (SABAs), an oral corticosteroid (OCS), or an emergency department (ED) asthma visit with an OCS prescription, or were hospitalized for their asthma.Results: Among 87,459 patients with new FPS claims, 60.8% were female, and the mean age was 37.3 years. Of these patients, 60,453 (69.1%) had no preindex ICS pharmacy claim or claims that would indicate moderate or severe asthma. In the preindex period, only 6.3% had received an ICS, 7.4% had >365 SABA doses, 22.7% had used an OCS, 1.1% had an ED visit with an OCS prescription, and 1.5% had been hospitalized.Conclusion: More than two thirds of the patients who initiated FPS treatment had neither received an ICS prescription before their first FPS pharmacy claim nor had evidence of asthma severity that would appear to warrant the use of an ICS/LABA combination.