Background Currently inhaled corticosteroids (ICS) alone, or in combined with inhaled long- acting beta2-agonist (LABA) is recommended for chronic asthma.

Objective This study aimed to assess the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in the Northern Sri Lanka.

Methods A prospective cohort study was carried out among adult patients with asthma on inhaled medications for at least three months. Participants were followed up for six months with two follow-up interviews three months apart. Primary outcome measure was asthma control which was assessed by a locally validated asthma control patient-reported outcome measure (AC-PROM). Secondary outcome measures were use of short-acting beta2-agonists, number of nebulisations and number of hospitalisations. Chi-squared test was used to determine the significance of differences in outcome measures between the two groups. Logistic regression was performed to determine the association between asthma control and socio-demographic factors. A p-value ≤ 0.05 was considered statistically significant.

Results Data from 1094 participants were analysed. Majority were females (73%) and belonged to age group >60 years (60%). Ratio between ICS monotherapy and combined therapy with ICS and LABA (ICS/LABA) was 3:1. A progressive improvement in asthma control was observed in both groups which was significant in those on ICS monotherapy (p<0.001). A significant reduction was also observed in overuse of short-acting beta2-agonist (p<0.001) and number of nebulisations (p=0.027) in participants on ICS monotherapy. No significant association between asthma control and socio-demographic factors was found in either group.

Conclusions Both ICS monotherapy and ICS/LABA were effective. However, treatment package comprising regular ICS plus non-pharmacological approaches would be more realistic and cost-effective treatment strategy in the local context. Considering the low availability and current economic status of Sri Lanka, ICS/LABA could be reserved for poorly controlled asthma.

What is already known on this topic?Inhaled corticosteroids (ICS) alone, or in combined with inhaled long-acting beta2-agonist (LABA) are recommended for the treatment of asthma. However, availability and affordability limit the use of inhaled medications in low and middle-income countries, particularly the combined therapy with ICS and LABA (ICS/LABA).

What this study adds This study was conducted in a real-life clinical setting to compare the effectiveness of ICS monotherapy and ICS/LABA. We found that close monitoring and improved communication positively impacted asthma control and exacerbations in both ICS monotherapy and ICS/LABA. These changes were significant in those on ICS monotherapy, but not in those on ICS/LABA.

How this study might affect research, practice, or policy Our study highlighted the importance of non-pharmacological approaches in the management of asthma. Promoting non-pharmacological approaches in routine clinical practice is likely to improve asthma control and reduce the need for escalation of treatment leading to improved quality of life and reduced healthcare costs.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka (EC-18-108) and administrative approvals were obtained from relevant authorities before commencing the data collection.

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All data produced in the present study are available upon reasonable request to the authors