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Combination Therapy:

its role in asthma management

 
 
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Combination Therapy
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Combination Therapy
Rationale & Evidence
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Use in Children
Dosage & Administration
Dose Titration & Patient Expectations
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Content created Mar 2002
Page updated 31 Aug 2005

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ForwardBackDosage and administration of combination therapy

Combination therapy medications are available in both metered dose inhaler (MDI) and dry powder inhaler (DPI) forms. Comparison of the medication delivery between devices and resulting asthma control has produced similar results. However, individual variation in clinical response between devices may occur. Regardless of which type of device is considered to provide the best results, the choice of inhaler device for an individual should be based upon patient factors, e.g. the age, strength, dexterity, vision, cognition, inspiratory flow rate and personal preference of the person with asthma.

Combination medications are available in a range of strengths. The difference lies in the ICS dose; the LABA dose remains constant. Dosing guidelines matching a combination medication to a person’s asthma severity have been developed for adults – these may change as our experience with the therapies increases. 

  • Mild persistent asthma – if a person is on a low dose of ICS (e.g. 200-250mcg/day of FP or BDP-HFA or 400-500 mcg/day BUD/BDP (CFC)) and has persistent symptoms, consider combination medication with low dose ICS or increase the dose of the ICS. 
  • Moderate asthma – try a moderate dose of ICS (e.g. 500mcg/day of FP or BDP-HFA or 800-1000mcg/day of BUD/BDP (CFC)) in combination medication as a first option before increasing the ICS dose. 
  • Severe asthma – use a higher strength ICS in combination with LABA (e.g. 500-1000mcg/day of FP/BDP-HFA or 1000-2000mcg/day BUD/BDP (CFC)) and consider referral for specialist assessment if this does not achieve optimal asthma control. 

There is limited evidence supporting an increase in ICS for management of acute exacerbations of asthma, but there is no current evidence regarding increases in medication for those already using combination therapy. The traditional practice of increasing the patient’s usual ICS dose would also increase the dose of the LABA. At present there is limited evidence to support this approach and it cannot be recommended. However, it is acknowledged that the most practical and cost-effective option for the patient may be to do this while seeking medical advice.