Choosing combination therapy for asthma: results of a pan-European attitudinal survey

Background. A recent Delphi consensus found that the factors considered to be most important in the selection of inhaled corticosteroids (ICSs) and long-acting β₂-agonists (LABAs) as part of a stepped approach to asthma management are: flexibility of dosing (88% agreement), long-term safety of the ICS and LABA (81%), clinical efficacy (81%),  LABA speed of onset (69%) and ICS potency (69%). An attitudinal research survey was subsequently developed to evaluate whether physician attitudes in real-life practice are similar to the expert consensus. The aim of this study was to evaluate physician attitudes towards combination therapies for asthma and to identify important factors influencing treatment in the real-world setting.

Methods. Based on the responses of the Delphi consensus group, an attitudinal questionnaire was developed, translated and pilot-tested in face-to-face interviews. Computer-assisted web interviews were then conducted by Kantar Health in 13 European countries. Physicians who treated fewer than 15 asthma patients a month or who had responded to previous surveys on asthma in the past 3 months were excluded.

Results. Of 1861 respondents, 1007 (54%) were eligible for inclusion; 85% of eligible respondents were respiratory specialists and 15% were primary physicians with a specialist interest in asthma, treating a mean of 59 asthma patients per month. Half (50%) of the patients with asthma were being treated with ICS/LABA fixed combinations, 15% with ICS alone, 10% with ICS/LABA free combinations, 10% with short-acting β₂-agonists alone, other therapy (10%) and 5% with LABAs alone. When choosing an ICS/LABA combination, the factors considered the most important (ranked 1 or 2 out of 5) were symptom improvement (71%), ICS potency (55%), improvement in fixed expiratory volume in 1 second (FEV₁; 50%), safety and tolerability (43%), speed of onset (42%), flexibility of dosing (40%) and duration of action (37%).

Conclusion: In this pan-European survey, physician attitudes to ICS/LABA therapy differed from those observed in the Delphi consensus in terms of the importance given to specific treatment attributes. However, both initiatives indicated that clinical efficacy, safety and tolerability, speed of onset of the LABA, potency of the ICS, and flexibility of dosing influence the choice of treatment in real-life practice.