Inhaled Corticosteroid/Long-Acting β₂-Agonist Combination Therapy for Asthma: Attitudes of Specialists in Europe

Abstract

Background: As new combinations of inhaled corticosteroids (ICSs) and long-acting β₂-agonists (LABAs) become available for the treatment of asthma, it will be important to determine criteria against which they can be evaluated. The aim of this study was to assess which attributes of combination therapy physicians consider most important. Methods: Primary and secondary care asthma specialists (n = 32) were recruited for an expert Delphi process that was performed over three rounds to determine attributes perceived to be important in the selection of combination therapy. A pan-European survey was carried out to assess the attitudes, perceptions and prescribing behaviour of a larger population (n = 1,861) of physicians with a specialist interest in asthma treatment. Results: The expert Delphi panel (response rate 59.4%) agreed that the availability of a range of doses (88% agreement in the final round), the efficacy of the combination (81%) and the safety and tolerability of the therapy (81%) were important attributes of ICS/LABA combination treatment. The potency of the ICS (69%) and the speed of onset of the LABA (69%) were also prioritized. The results of the attitudinal survey (eligibility rate 54.1%) showed that the same factors were considered important in everyday clinical practice. Conclusions: These studies identified which attributes of an ICS/LABA treatment are considered most important by an expert panel and a broader group of physicians; further research is warranted to better understand the influences that drive physician opinions.

Revising old principles of inhaled treatment in new fixed combinations for asthma

“…A rapid onset of action is important to patients, who want to feel their combination therapy working quickly, while providing lasting therapeutic benefits [59]. This is confirmed by the results of a Delphi initiative, which showed that expert respiratory specialists considered the potency of the ICS and speed of onset of the LABA among the most important factors when prescribing an ICS/LABA combination therapy for asthma [60]. Taken together, these data suggest that the combination of the ICS FP, which has potent anti-inflammatory effects, and the LABA FF, which provides rapid bronchodilation, provides an additional treatment option for asthma that may be valued by both physicians and patients for therapeutic efficacy and patient compliance.…”

Safety and efficacy of fluticasone/formoterol combination therapy in adolescent and adult patients with mild-to-moderate asthma: a randomised controlled trial

“…The LABA, formoterol fumarate (formoterol), has rapid, dose-dependent bronchodilatory effects, with an onset of action of 1 to 3 minutes [23], similar to salbutamol and faster than that of salmeterol [24-27]. Extensive research into the safety and efficacy of these two molecules is widely documented in the literature [19-30], and suggests that the fluticasone/formoterol combination may provide clinicians with a new and efficacious treatment for the management of persistent asthma.…”

Fluticasone propionate/formoterol: A fixed-combination therapy with flexible dosage

“…GPs and specialists from European countries were asked to complete Delphi questionnaires and to take sequential surveys. At the end of this survey, a panel of experts highlighted six main characteristics of ICS/LABA combination treatment: i) dosage flexibility (88% of attendees), ii) safety and long-term tolerability of ICS (81%), iii) safety and long-term tolerability of LABA (81%), iv) efficacy in asthma control (69%), v) anti-inflammatory power of ICS (69%), vi) rapid bronchodilator activity of LABA (68%) [ Table 1] [29].…”

“…Table 1 Expert panel agreement ⁎ on the characteristics of an effective ICS/LABA combination therapy. The results refer to the final round of a Delphi process [29].…”