Controller medications and their effects on asthma exacerbations temporally associated with upper respiratory infections☆

Summary 

Background

Exacerbations are a major risk and a cause of asthma morbidity and healthcare utilization. Viral-induced upper respiratory tract infections are the most frequent trigger of asthma-related exacerbations. Studies have traditionally assessed exacerbations without documentation regarding exacerbation etiology. Therefore, it remains unknown whether asthma medications can alter exacerbation susceptibility based on a specific etiology.

Objective

To examine whether treatment with inhaled corticosteroids plus long-acting beta₂-agonists reduced the number of exacerbations associated with upper respiratory tract infections versus inhaled corticosteroids alone.

Methods

Two large datasets comparing treatment with fluticasone propionate and fluticasone propionate plus salmeterol were analyzed, including the number of clinically reported upper respiratory tract infections, asthma-related exacerbations, and the presence of an exacerbation and concurrent report of an upper respiratory tract infection.

Results

Both treatment groups had similar incidences of upper respiratory tract infections. Of those reporting an upper respiratory tract infection, statistically significantly fewer reported an asthma-related exacerbation comparing fluticasone propionate plus salmeterol with fluticasone propionate (p=0.0057).

Discussion

This retrospective analysis suggests that therapy with fluticasone propionate plus salmeterol provides protection against asthma exacerbations temporally associated with upper respiratory tract infections. This retrospective analysis supports the hypothesis that specific therapeutic approaches to mitigate virus-associated exacerbations may benefit asthma care. Well-controlled prospective studies are warranted.

Keywords: Asthma, Exacerbation, Fluticasone propionate, Rhinovirus, Respiratory tract infection, Salmeterol

Abbreviations: AE, adverse event, CAMP, Childhood Asthma Management Program, FP, fluticasone propionate, GOAL, Gaining Optimal Asthma ControL, ICS, inhaled corticosteroids, LABA, long-acting beta agonist, NHLBI, National Health Lung and Blood Institute, PEAK, Prevention of Early Asthma in Kids, RCT, randomized clinical trials, RV, rhinovirus, SAL, salmeterol, URTI, upper respiratory tract infection