Dispensing of fluticasone propionate/salmeterol combination in the summer and asthma-related outcomes in the fall
Received 25 August 2008; received in revised form 9 July 2009; accepted 6 August 2009. published online 12 November 2009.
Background
Asthma exacerbations occur year-round; however, peak asthma-related events occur in the fall and are frequently associated with viral respiratory infections.
Objective
To compare the rates of asthma-related emergency department (ED) visits and hospitalizations in the fall (September, October, November) between users and nonusers of fluticasone propionate plus salmeterol in a single inhaler (FSC) in the preceding summer.
Methods
This was a retrospective, observational study using health care claims from a large managed care database. Patients age 4 to 55 years with both a medical claim for asthma and a pharmacy claim for FSC were categorized into 3 age groups: children (4-11 years), adolescents (12-18 years), and adults (19-55 years).
Results
There were 201,973 observations of FSC dispensings and 184,143 observations without FSC. Across all age groups, summertime dispensings of FSC were associated with a significantly lower (P < .001) risk of an asthma-related ED visit (4-11 years: adjusted odds ratio [OR], 0.54, 95% CI, 0.49-0.60; 12-18 years: OR, 0.59, 95% CI, 0.54-0.64; 19-55 years: OR, 0.53, 95% CI, 0.51-0.55) or hospitalization (4-11 years: OR, 0.43, 95% CI, 0.35-0.54; 12-18 years: OR, 0.49, 95% CI, 0.40-0.60; 19-55 years: OR, 0.61, 95% CI, 0.57-0.65) in the subsequent fall. This protective effect persisted even for patients with fall dispensings of FSC. The risk of oral corticosteroid dispensing in the fall was also significantly reduced in all age groups.
Conclusion
Summertime dispensings of FSC were associated with a decreased risk of serious asthma-related outcomes in the subsequent fall. Continuous use of FSC before seasonal viral exposure may decrease seasonally related exacerbations.
Reprint requests: Joseph Spahn, MD, Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology in Pediatrics, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206.
Disclosure of potential conflict of interest: R. H. Stanford and D. A. Stempel are employees of GlaxoSmithKline. J. Spahn has received honoraria and served as a consultant for GlaxoSmithKline, has received research support from Merck, and has served as an expert witness for GlaxoSmithKline. K. Sheth has received honoraria from Alcon, AstraZeneca, and Sanofi; has served as a consultant for Sepracor (Altana); and has received honoraria and served as a consultant for GlaxoSmithKline. W.-S. Yeh has received consulting fees from GlaxoSmithKline.
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