{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:43:54Z","timestamp":1772163834362,"version":"3.50.1"},"reference-count":46,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,2,12]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Inhaled corticosteroids (ICS) alone, or combined with long-acting beta\n                      <jats:sub>2<\/jats:sub>\n                      -agonist (LABA), are recommended for chronic asthma. Limited access to inhaled medications hinders effective control of asthma in low-income and middle-income countries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to compare the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in Northern Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective cohort study was conducted among adult patients with asthma on either ICS alone or ICS\/LABA combination for at least 3\u2009months. Participants were followed up for 6\u2009months, with two follow-up interviews conducted 3\u2009months apart. The primary outcome measure was asthma control, assessed by a locally validated asthma control patient-reported outcome measure. Secondary outcome measures included the use of short-acting beta\n                      <jats:sub>2<\/jats:sub>\n                      -agonists (SABA) and the percentage of patients required nebulisations and hospitalisations. McNemar\u2019s test was used to determine the statistical significance. A p value\u22640.05 was considered significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1094 participants, 827 (76%) were on ICS monotherapy and 267 (24%) were on ICS\/LABA. Though there were no changes in the treatment, progressive improvement in asthma control was observed from baseline to second follow-up in both ICS (54%\u201372%) and ICS\/LABA (76%\u201381%) groups. Significant improvement in asthma control (p&lt;0.001) and SABA overuse (p&lt;0.001) at both follow-ups and nebulisation (0.008) at the first follow-up were observed in the ICS group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both ICS monotherapy and ICS\/LABA were effective in controlling asthma. Though control was greater with ICS\/LABA, the effect of additional monitoring during the follow-up was higher and significant in ICS monotherapy. Considering the low access to ICS\/LABA, a treatment package comprising ICS plus non-pharmacological approaches could be a more realistic and cost-effective treatment strategy in the local context. ICS\/LABA could be reserved for patients who fail to respond. However, this observation needs to be confirmed by interventional studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2024-002675","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T23:25:21Z","timestamp":1740698721000},"page":"e002675","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of inhaled therapies in asthma among adults in Northern Sri Lanka, a low-income and middle-income country: a prospective observational study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2082-8230","authenticated-orcid":false,"given":"Yalini","family":"Guruparan","sequence":"first","affiliation":[{"name":"Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thiyahiny","family":"S Navaratinaraja","sequence":"additional","affiliation":[{"name":"Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gowry","family":"Selvaratnam","sequence":"additional","affiliation":[{"name":"Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shalini","family":"Sri Ranganathan","sequence":"additional","affiliation":[{"name":"Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Western Province, Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"2026010701502086000_12.1.e002675.1","unstructured":"Global Initiative for Asthma . 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