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Medication Options for Treating Asthma1-4
The 2007 National Heart, Lung and Blood Institute (NHLBI) “Guidelines for the Diagnosis and Management of Asthma” recognize the following treatments for asthma:

  • Inhaled Corticosteroids (ICS)
  • Titrated (increased) doses if ICS is administered alone or with a long-acting beta2-agonist (LABA).

Safety Concerns for LABA’s and Combination Products

  • The combination products budesonide/formoterol (Symbicort) and fluticasone/salmeterol (Advair) are also associated with an increased the risk of asthma-related death. Over 28 weeks, the chance of death in patients treated with salmeterol versus those treated with placebo was one out of every 1,250 Caucasians and one out of every 370 African Americans.
  • There is no evidence that an ICS added to a LABA offers protection against asthma-related deaths associated with LABAs. 

The NHLBI Guidelines and clinical studies suggest that Advair® and Symbicort® should be reserved for patients not adequately controlled on ICS products. However, Regence prescription claim data indicate that up to 87% of Advair  prescriptions are used first-line. 

Regence Preferred/Formulary Options
Single agent ICS’s and LABA’s are available as preferred/formulary to offer the best flexibility in dosing and supports clinical practice guidelines:

Preferred Inhaled Steroids:
Asmanex®                    Pulmicort®
Azmacort®                   Pulmicort Respules®
Flovent®                       QVAR® 		Preferred Inhaled Bronchial Dilators:
Foradil®
Serevent Diskus®

When asthma is not adequately controlled on ICS products or two maintenance therapies at stable doses are clearly warranted, the combination product Advair® is available to Regence members as preferred/formulary effective June 1, 2008. 

 

REFERENCES:
1.  National Heart, Lung, and Blood Institute (NHLBI); National Asthma Education and Prevention Program: Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma; 2007. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
2.  Global Initiative for Asthma (GINA) Report, Global Strategy for Asthma Management and Prevention Revised November 2006. http://www.ginasthma.com/Guidelineitem.asp?l1=2&l2=1&intId=60
3.  Advair® HFA (fluticasone propionate; salmeterol xinafoate) Prescribing Information.  June 2006.  GlaxoSmithKline, Research Triangle Park, NC.
4.  Advair® Diskus® (fluticasone propionate; salmeterol xinafoate) Prescribing Information.  April 2008.  GlaxoSmithKline, Research Triangle Park, NC