Experts reach agreement on important attributes of combination therapies for asthma

1st April 2013

Data presented today at the World Allergy Organization (WAO) International Conference have shown that: clinical efficacy, safety, tolerability and speed of onset of a long-acting β2-agonist (LABA), potency of an inhaled corticosteroid (ICS), and flexibility of dosing are the most important attributes that influence an expert’s choice of a combination therapy to treat asthma.1 This  study, undertaken under the auspices of the Global Allergy and Asthma European Network (GA2LEN), used the Delphi process, a validated consensus-development methodology that enables a group of experts to deal with a complex problem through rounds of structured feedback.

‘‘Given the lack of clear guidelines on selecting a specific ICS/LABA therapy for asthma and the absence of conclusive evidence supporting differences in clinical efficacy between the available combinations, this consensus has the potential to provide physicians with better direction and confidence when choosing the best option for their patients”, commented Professor David Price, Centre of Academic Primary Care, University of Aberdeen, UK.

According to this study, the factors considered to be the most important in the selection of a combination therapy as part of a stepped approach to asthma management were ranked in the following order: flexibility of dosing (88% agreement), long-term safety of the ICS and LABA (81 per cent), clinical efficacy (81 per cent),  LABA speed of onset (69 per cent) and ICS potency (69 per cent)1,2.

The findings from another study, presented at the WAO congress, support the results from the Delphi process by indicating similar attributes of combinations are important to physicians.2 This attitudinal study, which looked at the views of over 1,000 respiratory specialists and primary care physicians, from 13 EU countries, in real-life practice identified the symptom improvement (71 per cent) and ICS potency (55%) as the most important attributes, followed by improvement in fixed expiratory volume in 1 second (FEV1; 50 per cent), safety and tolerability (43 per cent), speed of onset (42 per cent), flexibility of dosing (40 per cent) and duration of action (37 per cent)2.

A further study, presented at the WAO conference, showed an increasing trend in the prescribing of fixed combinations of an ICS and a LABA over the period 2004–2009 whereas there was a slight decline in the prescribing of ICSs alone or in free combination with a LABA over the same period.3 The study found that overall fluticasone was the most widely prescribed ICS in Europe and the most widely prescribed ICS in fixed dose combination inhalers3.

All studies were supported by investment from Mundipharma. ‘‘Mundipharma’s support for these studies shows its commitment and investment in research which will inform the development of better treatment strategies in asthma and ultimately lead to reducing the individual and societal burden of this debilitating condition” said Professor Dr Karen Reimer, European R&D Director at Mundipharma.

GA2LEN undertook a Delphi process in order to reach agreement on which factors are considered to be the most important to take into account when choosing an ICS/LABA combination for asthma. Thirty-two experts from 9 European countries (Austria, Finland, France, Germany, Italy, Spain, Sweden, Switzerland and the UK) were invited to participate. Three rounds of structured feedback were considered in this Delphi process.

Based on the responses of the Delphi consensus group, an attitudinal questionnaire was developed, translated and pilot-tested in face-to-face interviews. Computer-assisted web interviews were then conducted in 13 European countries. Of 1861 respondents, 1007 (54 per cent) were eligible for inclusion; 85 per cent of eligible respondents were respiratory specialists and 15 per cent were primary physicians with a special interest in asthma, treating a mean of 59 asthma patients per month. Half (50 per cent) of the patients with asthma were being treated with ICS/LABA fixed combinations, 15 per cent with ICS alone, 10 per cent with ICS/LABA free combinations, 10 per cent with short-acting β2-agonists alone, other therapy (10 per cent) and 5 per cent with LABAs alone.
The study gathered information on the retail prescribing of ICSs and LABAs in 12 European countries (Austria, Denmark, Finland, France, Germany, Ireland, Italy, Netherlands, Spain, Sweden, Switzerland and UK) between Q4 2004 and Q3 2009. For each formulation of each treatment, the number of actuations was converted to the number of inhalers prescribed.
For more information, visit
1. Price D, Bousquet J. Combination therapy for asthma: results of a Delphi process. Abstract presented at World Allergy Organization (WAO) International Conference in Dubai, 5–8 December 2010
2. Price D. Choosing combination therapy for asthma: results of a pan-European attitudinal survey. Abstract presented at World Allergy Organization (WAO) International Conference in Dubai, 5–8 December 2010
3. Price D. Trends in prescribing inhaled corticosteroids alone and in combination with long-acting β2-agonists in Europe in 2004–2009. Abstract presented at World Allergy Organization (WAO) International Conference in Dubai, 5–8 December 2010





To receive the Scientist Live weekly email NewsBrief please enter your details below

Twitter Icon © Setform Limited