Asthma is a chronic lung disease characterized by reversible airway obstruction, inflammation, and increased airway responsiveness. There are currently two categories of medications used in asthma treatment: controller medications and quick relief (or rescue) medications. Although all patients with persistent asthma should have a short-acting relief medication on hand for treatment of exacerbations and a controller medication for long-term control, this report will focus on the following currently available controller medications: inhaled corticosteroids (ICSs), Long-Acting Beta-2 Agonists (LABAs), leukotriene modifiers, anti-IgE medications, and combination products. The purpose of this review is to compare the benefits and harms of controller medications used in the treatment of persistent asthma as, well as look for subgroups that may differ in these areas, to assist healthcare providers and policy makers in making clinical decisions, creating formularies, and developing policies regarding long-term asthma control medications based on the most current available literature.

Contents

• Introduction
  • Purpose and Limitations of Evidence Reports
  • Scope and Key Questions
  • Inclusion Criteria
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Validity Assessment (Quality Assessment)
  • Identification of Effectiveness Trials
  • Data Synthesis
  • Overall Strength of Evidence
  • Peer Review and Public Comment
• Results
  • Overview
  • Key Question 1. Efficacy and Effectiveness
  • Key Question 2. Adverse Events
  • Key Question 3
• Summary
• References
• Appendix A. Search Strategies
• Appendix B. Glossary
• Appendix C. Quality assessment methods for drug class reviews for the Drug Effectiveness Review Project
• Appendix D. Characteristics of excluded studies for poor quality
• Appendix E. Placebo-controlled trials (not included)
• Appendix F. Summary table of adverse events and tolerability from head-to-head RCTs comparing ICSs
• Appendix G. Meta-analyses
• Evidence Tables

Oregon Evidence-based Practice Center, Oregon Health & Science University, Mark Helfand, MD, MPH, Director

The Drug Effectiveness Review Project, made up of 15 organizations including 14 state Medicaid agencies, commissioned and funded this report. These organizations selected the topic of the report and had input into its Key Questions. Content and conclusions of the report were determined entirely by researchers at the Evidence-based Practice Center. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in the report.

Suggested citation:

Jonas DE, Kiser K, Bryant Shilliday B, Morgan LC, Thieda P, Reuland D. Drug class review: Controller medications for asthma.

The Agency for Healthcare Research and Quality has not yet seen or approved this report.

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.