Asthma severity in patients initiating controller monotherapy versus combination therapy

Background: Asthma treatment guidelines recommend medications based on the level of asthma control. Objective: To evaluate differences in asthma control between patients who initiated asthma controller monotherapy versus combination therapy. Patients and methods: Children (5-16 years; n = 488) and adults (17-80 years; n = 530) with asthma and no controller therapy in the prior 6 months were included. Telephone surveys were conducted within 5 days of filling a new asthma controller prescription with either the caregiver of children or the adult patient. Demographics, asthma control before therapy, and asthma-related resource use were assessed for patients initiating monotherapy (filling one asthma controller prescription) and combination therapy (filling more than one controller medication or a fixed-dose combination). Results: Mean pediatric age was 10 years; 53% were male. Mean adult age was 47 years; 25% were male. There were no significant differences in asthma control score between patients receiving monotherapy and combination therapy. Children on combination therapy did not have more nighttime awakening or short-acting β-agonist use but were more likely to have been hospitalized due to asthma attack (p =.05) and have more unscheduled (p =.0374) and scheduled (p =.009) physician visits. Adults on combination therapy were more likely to have been hospitalized due to asthma attack (p <.05) and have regular doctor visits for asthma (p <.01). Conclusions: Assessment of asthma control scores in the 4 weeks before index medication suggests that asthma severity during a treatment-free period did not differ significantly for patients initiating controller monotherapy versus combination therapy. From these findings, it appears that although physicians may not focus on asthma control when choosing the intensity of initial controller therapy, the intensity of health-care encounters may be an influence.