A Comparison of the Effectiveness of Asthma Medications on Asthma Exacerbations in Real World National Cohort

Hye Jung Park, Soyoung Jeon, Hye Sun Lee, Bo Yeon Kim, Yu Jin Chae, Gui Ok Kim, Jung Won Park, Jae Hyun Lee

Research output: Contribution to journalArticlepeer-review


Background: Although a wide variety of asthma medications have been developed and are used in clinical practice, there is limited evidence of their comparative effects on asthma exacerbations. Methods: We used claims data provided by the Health Insurance Review and Assessment Service. We selected subjects commencing asthma treatment between July 1, 2017 and June 30, 2018, with no change in drug regimen. The primary outcome was asthma exacerbation requiring systemic corticosteroids. Cox regression analysis was used to assess outcomes considering the exacerbation-free period. Results: Of the 254,951 asthma subjects, 107,694 subjects (42.2%) experienced asthma exacerbation. Inhaled corticosteroids (ICSs) (hazard ratio [HR], 0.378–0.508), ICS-long-acting β2-agonist (LABAs) (HR, 0.284–0.479), long-acting muscarine antagonists (LAMAs) (HR, 0.432–0.572), leukotriene receptor antagonists (LTRAs) (HR, 0.371–0.419), and xanthines (HR, 0.326–0.482) significantly reduced the rate of first and second exacerbation of asthma (all P-values, <0.001). The clinical effectiveness of asthma medications varied according to the active ingredient (HR 0.164–0.670) and was significant for all active ingredients (all P-values, <0.001). The effectiveness of combination treatment using ICS-LABA and LTRA varied (HR, 0.159–0.670); however, all combination treatment options evaluated were effective in preventing asthma exacerbations (all P-values, <0.001). Long-term use of ICS-LABA (HR, 0.278–0.653), LTRA (HR, 0.259–0.628), and xanthines (HR, 0.351–0.783) showed consistent effectiveness (all P-values, <0.001). Conclusion: This real-world study showed that the effectiveness of asthma medications varied according to drug type, active ingredient, combination, and period of use, although effectiveness was significant in all cases studied.

Original languageEnglish
Pages (from-to)1155-1165
Number of pages11
JournalJournal of Asthma and Allergy
Publication statusPublished - 2022 Aug

Bibliographical note

Funding Information:
We are really pleased to have participated in the Joint Project on Quality Assessment Research in 2021 and used quality assessment data of Health Insurance Review & Assessment Service (HIRA). This research was supported by a grant (22213MFDS486) from Ministry of Food and Drug Safety in 2022.

Publisher Copyright:
© 2022 Park et al.

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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