OBJECTIVES: Exacerbations – consequence of poor control of asthma - are the main component of high cost of this disease. The aim of the study was the cost comparison of managing asthma exacerbations with two types of treatment: stable dosing of SFC and AMD of FBC. METHOD: The analysis was performed from health-care payer perspective, based on Polish data on health-care resource utilisation and unit cost obtained from COAX study, estimating cost of asthma exacerbation managed in primary and secondary care in Poland. Data on incidence of asthma exacerbations in two types of treatment were derived from 1-year CONCEPT Trial - the only available double blind, double dummy, randomized study in adults with persistent asthma, comparing stable dosing SFC with AMD of FBC. RESULTS: Study population was 688 patients (344 in each treatment arm). 11.3% patients on stable dosing of SFC experienced an asthma exacerbation compared with 17.7% patients receiving AMD of FBC. There were 48% fewer exacerbations in the stable dosing SFC group than in AMD with FBC (50 vs. 96 exacerbations respectively). The incidence of asthma exacerbations requiring oral steroids or an emergency room visit/hospitalization was 47% lower for the stable dosing SFC group than for AMD with FBC (adjusted annual mean rate, 0.18 vs 0.33; P = 0.008). The total annual direct healthcare costs of managing exacerbations for the stable dosing SFC group was PLN 19.833 compared with PLN 34.936 for the AMD with FBC group. Difference in annual costs of managing exacerbations was PLN 15.103 (EUR 1= PLN 4,02; year 2005). CONCLUSION: Stable dose treatment with salmeterol/fluticasone combined product of adult patients with persistent asthma is more effective than the adjustable maintenance dosing with formoterol/budesonide combined product and reduces the cost of exacerbations management by 43%.