Physicians’ attitudes towards combination therapy with inhaled corticosteroids and long-acting β2-agonists: an observational study in UK specialist care

PURPOSE: Recent real-world studies have demonstrated that asthma control remains suboptimal in many patients. The aim of this study was to evaluate physicians' perceptions of the effectiveness of combination therapy with an inhaled corticosteroid (ICS) and a long-acting β₂-agonist (LABA) in routine clinical practice. METHODS: In November 2009, UK respiratory specialists were invited by medeConnect Healthcare Insight to complete a survey on the effectiveness of different single- or dual-inhaler combinations of an ICS and a LABA in the context of asthma management. Respondents were permitted to specify combinations of available ICSs and LABAs, based on their knowledge and experience of the individual components. Questions elicited both unprompted free-text responses and prompted responses selected from a list of options. RESULTS: A total of 98 physicians completed the survey, of whom 82 (84%) gave permission to publish their data. The majority of respondents (63%) were consultants and 57% reported a caseload of more than 40 patients with asthma or chronic obstructive pulmonary disease per month. Fluticasone and formoterol were considered to be the most effective combination for the treatment of asthma (37% unprompted, 41% prompted), followed by budesonide and formoterol (22% unprompted, 24% prompted). The most common reasons for choosing specific combinations were: rapid onset of action (60%), high potency of the ICS (39%), efficacy (15%), experience of prescribing (13%), clinical evidence (12%), and long-lasting effect (10%). Key properties of the preferred fluticasone and formoterol combination were rapid onset of action and high potency of the ICS (79% for both). CONCLUSION: The results of this survey suggest that the ICS and LABA combination considered most effective by UK physicians in the management of asthma is fluticasone and formoterol, which is not currently available as a single-inhaler combination. The development of new single-inhaler combinations of ICSs and LABAs may improve real-world asthma management.