ERS 2020 — Asthma: overprescription of LAMA monotherapy is concerning


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • Long-acting muscarinic antagonists (LAMAs) as monotherapy are frequently prescribed in patients with asthma and are associated with an increased risk of exacerbations. 
  • The findings highlight the need to check for use of inhaled corticosteroid (ICS) when prescribing LAMAs.

Why this matters

  • LAMAs are indicated as add-on treatment in patients with asthma; their use alone remains controversial.

Study design

  • ALPACA study: a cohort analysis in the Integrated Primary Care Information database included patients with asthma aged 6-50 years (n=66,508) who were using LAMA therapy during follow-up. 
  • Treatment was categorized into LAMA monotherapy, dual therapy (LAMA + ICS), or triple therapy (LAMA + ICS + long-acting beta-agonist).
  • Funding: None disclosed.

Key results

  • 38.7% of patients were LAMA monotherapy users, 15.4% were double therapy users, and 46.0% were triple therapy users.
  • Among LAMA users, those receiving monotherapy had a relative severe asthma exacerbation risk of 1.58 (95% CI, 0.52-4.77; P=.42) vs those receiving double therapy. 
  • After excluding triple therapy users, the relative risk of severe exacerbations increased to 5.72 (95% CI, 1.39-23.62; P=.02).
  • Other risk factors for severe exacerbations among all LAMA users were female sex (relative risk [RR], 1.63; 95% CI, 1.10-2.42; P=.016) and history of previous exacerbations (RR, 1.81; 95% CI, 1.63-2.00; P<.001>

Limitations

  • Observational design.