Purpose Currently, there are multiple options for the pharmacological treatment of asthma. This study aimed to compare the effects of different asthma medications on exacerbation in a real-world setting. Materials and Methods We retrospectively reviewed electronic medical records of asthma patients who visited the hospital from November 1, 2016 to October 31, 2019. The number of asthma exacerbations requiring administration of systemic steroids was the primary outcome. A time-varying Cox regression analysis was used to reflect the real-world setting: variable usage times, discontinuation, and switching of medication. Results Among 937 patients with asthma, 228 (24.3%) experienced asthma exacerbation during the study period. Asthma exacerbation was observed in patients using short-acting β 2 -agonists (SABA) alone (50.4% vs. 28.6%, p <0.001) as well as in patients not using inhaled corticosteroids (ICS) (58.8% vs. 40.3%, p <0.001), long-acting β 2 -agonists (LABA) (54.8% vs. 36.1%, p <0.001), and leukotriene receptor antagonists (71.5% vs. 50.8%, p <0.001). A time-varying Cox regression analysis of asthma exacerbations according to the duration of asthma medication showed that SABA alone increased the risk of asthma exacerbation [hazard ratio (HR), 1.834; 95% confidence interval (CI), 1.299–2.588; p =0.001], whereas ICS-LABA decreased the risk (HR, 0.733; 95% CI, 0.538–0.997; p =0.048). However, in the subgroup analysis according to medication type, specific ingredients showed no significant differences. Conclusion In the real world, asthma medications affect asthma exacerbation variably according to the medication type.

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