The role of inhaled corticosteroids in asthma treatment: a health economic perspective

Asthma affects approximately 23 million American children and adults, resulting in almost 15 million physician office and hospital visits, and nearly 2 million emergency department visits each year. Despite the publication of National Asthma Education and Prevention Program guidelines, asthma remains poorly controlled, with annual costs estimated at up to $56 billion. Current guidelines recommend long-term treatment with inhaled corticosteroids (ICS) because of their superior effectiveness in managing the chronic airway inflammation that characterizes persistent asthma. ICS monotherapy should be explored before alternatives such as leukotriene modifiers and long-acting beta agonists (LABAs) are attempted, especially after the US Food and Drug Administration's 2010 warning that LABAs should never be used alone to treat asthma due to the increased risk of severe exacerbations leading to hospitalization in both children and adults, with a possibility of death. In the past, asthma treatment focused solely on the central airways, rather than the small, more distant airways, and most traditional ICS therapies are aerosols which deliver large particles to the central airways. Today, the importance of the role of small airway disease in asthma, particularly inflammation, is known. Targeting the small airways may help improve clinical outcomes and reduce healthcare utilization and costs. The ICS beclomethasone dipropionate HFA does not require a spacer and is characterized by small particle sizes that result in more of the drug being deposited in both the large and small airways. Studies have demonstrated that beclomethasone dipropionate HFA is clinically effective and cost efficient compared with other asthma monotherapies or combination therapies.