Abstract:
Background Inhaled corticosteroids (ICS) alone, or
combined with long-acting
beta2-agonist
(LABA), are
recommended for chronic asthma. Limited access to
inhaled medications hinders effective control of asthma in
low-income
and middle-income
countries.
Objective This study aimed to compare the effectiveness
of inhaled therapies in a cohort of adult patients with
asthma who were receiving treatment in a tertiary hospital
in Northern Sri Lanka.
Methods A prospective cohort study was conducted
among adult patients with asthma on either ICS alone or
ICS/LABA combination for at least 3 months. Participants
were followed up for 6 months, with two follow-up
interviews conducted 3 months apart. The primary
outcome measure was asthma control, assessed by
a locally validated asthma control patient-reported
outcome measure. Secondary outcome measures
included the use of short-acting
beta2-agonists
(SABA)
and the percentage of patients required nebulisations
and hospitalisations. McNemar’s test was used to
determine the statistical significance. A p value≤0.05
was considered significant.
Results Of the 1094 participants, 827 (76%) were on ICS
monotherapy and 267 (24%) were on ICS/LABA. Though
there were no changes in the treatment, progressive
improvement in asthma control was observed from
baseline to second follow-up
in both ICS (54%–72%) and
ICS/LABA (76%–81%) groups. Significant improvement in
asthma control (p<0.001) and SABA overuse (p<0.001) at
both follow-ups
and nebulisation (0.008) at the first follow-up
were observed in the ICS group.
Conclusion Both ICS monotherapy and ICS/LABA were
effective in controlling asthma. Though control was
greater with ICS/LABA, the effect of additional monitoring
during the follow-up
was higher and significant in
ICS monotherapy. Considering the low access to ICS/
LABA, a treatment package comprising ICS plus non-pharmacological
approaches could be a more realistic and
cost-effective
treatment strategy in the local context. ICS/
LABA could be reserved for patients who fail to respond.
However, this observation needs to be confirmed by
interventional studies.
