Maintenance asthma treatment with fluticasone/salmeterol combination via Diskus: effect on outcomes in inner-city children enrolled in TennCare.

Although current national guidelines suggest combination inhaled corticosteroid/long-acting inhaled beta2-agonist as the preferred treatment in moderate and severe persistent asthma for children, trials aimed at reducing emergency department (ED) visits and hospitalizations in minority inner-city children have not been conducted with the combination product of fluticasone/salmeterol via Diskus (Advair). This study assessed the effect of fluticasone/salmeterol combination via Diskus therapy on hospitalizations and ED visits in children with asthma. We conducted a prospective 1-year study with an intervention group compared with a usual care control group. This study took place at an inner-city university-affiliated children's medical center allergy clinic. Inner-city patients with asthma aged 4-17 years with a history of frequent ED visits and hospitalizations for the 2 previous years were enrolled beginning in July 2001. A control group of inner-city asthmatic patients was identified via hospital medical records. Patients were prescribed fluticasone/salmeterol combination via Diskus (n = 39) for 1 year and were compared with a usual care control group (n = 39). Although the investigators did not intervene in the control patients, review of their records revealed that all control patients had inhaled corticosteroids prescribed during the intervention period. Outcome measures included ED visits and hospitalizations for 1 year after enrollment versus the mean for acute care visits for 2 years before enrollment in the study. The intervention group had a 20% reduction in ED visits, which was significant compared with the control group (p = 0.017); both groups had significant reductions in hospitalizations. The risk of experiencing an asthma exacerbation (ED visit or hospitalization) was reduced by 33% in the intervention group compared with the control group (risk ratio, 0.67; 95% confidence interval, 0.49-0.90; p = 0.005). Our results suggest that fluticasone/salmeterol combination via Diskus is associated with a reduction in risk of acute exacerbations of asthma in inner-city children, including ED visits and hospitalizations.