Asthma management often includes long-term control medications to prevent asthma attacks and rescue medications for acute episodes.1 On January 1, 2024, the Flovent metered-dosed inhaler and the dry powder inhaler, both used for long-term asthma control, were discontinued and are no longer manufactured.2 The manufacturer is encouraging use of an authorized generic version of fluticasone propionate, but some providers and patients have shared concerns about insurance coverage for and effectiveness of the available alternatives on the market.2,3
To understand the effect on patients with asthma who depend on these long-acting medications, we looked at the rate of emergency department (ED) visits, admissions, and ICU stays for asthma in the periods before and after the change in availability of Flovent. We studied 3,312,869 patients who were prescribed fluticasone propionate within the six months preceding the quarter of interest. We studied only the first and second quarter of each year to control for seasonality. A patient’s fluticasone propionate prescription may have been for Flovent, the authorized generic, another brand, or an independent generic.
In the first and second quarters of 2024, the rates of all types of visits were higher than the same periods averaged over 2022 and 2023. When looking at inpatient admissions, the rate of visits which were asthma related increased 17.5% for Q1 and 24.1% for Q2 compared to the average of the same quarters in 2022 and 2023.
Asthma-related ICU admissions also increased in 2024. In the first quarter, the rates were 17.4% higher than the average of the same quarters in 2022 and 2023, while they were 21.3% higher in Q2.
Lastly, while still increased, the rate of asthma-related ED visits had the lowest increase of the encounter types. In Q1 2024, the rate was 6.5% higher than the average of the same quarter in 2022 and 2023, while in Q2 2024, the rate was 3.6% higher.
