Historical cohort study examining comparative effectiveness of albuterol inhalers with and without integrated dose counter for patients with asthma or chronic obstructive pulmonary disease

Abstract

BackgroundUsing a metered-dose inhaler (MDI) beyond the labeled number of actuations may result in inadequate dosing of medication, which can lead to poor clinical outcomes. This study compared respiratory-related emergency department (ED) visit rates in patients with asthma, chronic obstructive pulmonary disease, or both when they used albuterol MDIs with versus without dose counters.MethodsThis retrospective study used US claims data to identify patients (ages 4–64 years) with asthma, chronic obstructive pulmonary disease, or both, using albuterol MDIs with or without an integrated dose counter. The study comprised a 1-year baseline period for patient characterization and confounder definition and a 1-year outcome period following the first albuterol prescription. The primary end point was the incidence rate of respiratory-related ED visits, compared using a reduced zero-inflated Poisson regression model. We also compared severe exacerbation rates and rescue medication use.ResultsA total of 93,980 patients were studied, including 67,251 (72%) in the dose counter cohort and 26,729 (28%) in the non-dose-counter cohort. The cohorts were broadly similar at baseline (55,069 [59%] female patients; median age, 37 years). The incidence rate of respiratory-related ED visits during the outcome year was 45% lower in the dose counter cohort than in the non-dose-counter cohort (adjusted rate ratio: 0.55; 95% confidence interval: 0.47–0.64). Exacerbation rates and short-acting β-agonist use were similar between cohorts.ConclusionThese findings suggest that dose counter integration into albuterol MDIs is associated with decreased ED visit rates. The presence of integrated dose counters on rescue inhalers can help patients avoid using an empty or near-empty inhaler during exacerbations, thereby ensuring available medication for relief of their symptoms. Integrated dose counters on rescue MDIs could represent a simple and effective tool to improve clinical outcomes during exacerbations, with a potential for cost savings to health care systems.

The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA

“…Although in the current study eosinophil counts were not assessed as a risk factor, it was demonstrated that the proportion of patients experiencing ≥1 exacerbations during the follow-up period was higher in patients who had severe uncontrolled asthma (GINA Step 4/5 plus ≥2 exacerbations in the previous year) with eosinophil counts (≥300 cells/μl) than in patients who did not. The current study also demonstrated that females had a higher exacerbation risk than males, a result demonstrated in a previous study, [20] although not all studies are in agreement [21]. …”

Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir® HFA) with and without integrated dose counters

“…Consistent with our findings, a historical cohort study of 75,787 patients with asthma aged 4–64 years (53,964 using albuterol with a dose counter and 21,823 using albuterol without a dose counter) by Price et al demonstrated that patients using an inhaler with a dose counter had a 51% lower incidence of respiratory-related ED visits (adjusted rate ratio: 0.49; 95% CI 0.41–0.59) 22. The authors speculated that the albuterol dose counters may have enabled patients to determine when their rescue medication was empty, and/or when additional controller adherence was needed, thus preventing them from using an empty inhaler during an asthma exacerbation 22. The addition of a dose counter can help to reduce ED visits, thereby reducing health care costs associated with asthma.…”

“…The use of IDCs may contribute to improvements in the control of respiratory disease and respiratory-related health care utilization and costs. Results from a real-world study demonstrated reduced incidence of respiratory-related ED visits in patients using rescue inhalers with IDC compared to those with no dose counter on their inhalers 22. However, there is paucity of data on the real-world impact of ProAir HFA equipped with dose counters on HRU among patients with asthma.…”

Health care resource utilization and cost for asthma patients regularly treated with oral corticosteroids – a Swedish observational cohort study (PACEHR)

“…Increased eosinophils are associated with increased disease severity, more exacerbations and less well-controlled asthma [20–23]. Therefore, these patients may be eligible for treatment with biologics.…”