National Trends in Ambulatory Asthma Treatment, 1997-2009

Despite some decreases in mortality and morbidity over the past decade, asthma continues to be a major health concern.

The National Heart, Lung and Blood Institute has changed its treatment recommendations over the years. For example, in response to safety concerns, in 2006 (reiterated in 2010), the FDA issued a black-box warning against long-acting beta-agonists alone, recommending their use only with inhaled steroids and when steroids alone were insufficient.

Researchers sought to characterize changes in office-based asthma prescribing patterns from 1997 to 2009 for asthma patients less than 50 years old. They used data from the National Ambulatory Care Survey (NAMCS) and the National Disease and Therapeutic Index™ (NDTI), and focused on trends in the use of inhaled steroids, long-acting beta-agonists and the combination of the two agents.

They found marked changes in the rates of use of most asthma therapies—less short-acting beta-agonists (80% of visits in 1997 to 71% in 2009) and more inhaled steroids (24% in 1997 versus 33% in 2009). They also found the use of combined long-acting beta-agonists with inhaled steroids increased considerably since 1997. These findings are consistent with clinical guidelines that emphasize the important role of controller therapies in treating asthma.