Prescription practices of inhaled corticosteroids in combination with long-acting beta2 agonists in Indian children with asthma: Results of the RAINBOW survey

<bold>Background:</bold> Recent guidelines recommend the use of inhaled corticosteroids along with long-acting beta₂ agonist (ICS-LABA) in children uncontrolled with ICS alone. While ICS-LABA is widely used in adults, its usage for management of asthma in Indian children has not been adequately studied. <bold>Objectives:</bold> To understand prescription patterns of ICS-LABA in Indian children with asthma. <bold>Methods:</bold> A cross-sectional, digital survey was conducted among clinicians managing asthma in children. <bold>Results:</bold> 411 clinicians(57.2% respiratory physicians,42.8% pediatricians) participated in the survey. 23.4% respiratory physicians and 64.77%pediatricians(p<0.01) reported that they see >20 children/month with asthma. 63.4% respiratory physicians and 74.43%pediatricians reported that up to 50% pediatric asthma patients were on ICS-LABA combinations. Asthma uncontrolled on low-dose ICS(53.77%), ICS+leukotriene inhibitors(50.61%), PRN SABA(45.74%) or medium-dose ICS (40.88%) were key reasons cited for prescribing ICS-LABA. Reduction in day-time and night-time symptoms and emergency department visits were the most important clinical benefits cited with use of ICS-LABA. Budesonide-formoterol (71.29%) was the most preferred ICS-LABA with 75.18% clinicians preferring to use it as maintenance and reliever therapy (MART). pMDI+spacer (79.08%) was the most preferred device for management of asthma in children. <bold>Conclusion:</bold> We observed a significant preference for ICS-LABA and MART in asthmatic children uncontrolled with ICS which reflects shift of practice preferences in accordance with the recent guideline recommendations for management of pediatric asthma.