Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III

Abstract

Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment.Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries.The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis.Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.

A randomised controlled trial of the effect of a connected inhaler system on medication adherence in uncontrolled asthmatic patients

“…Although patients often over-estimate how much maintenance medication they use (34)(35)(36), they may also under-estimate how much rescue medication they use due to misperceptions about their airway obstruction (37) and seeing objective data for their rescue use appeared to affect this. Numerous surveys and reports have highlighted the serious consequences of under-using asthma maintenance therapy and overusing rescue medications, (4,(38)(39)(40), and both have been identified as contributory risk factors for asthma deaths (39). The problem of non-adherence is also significant in more severe disease.…”

“…In our study, seeing objective data for their rescue use appeared to affect this. Numerous surveys and reports have highlighted the serious consequences of under-using asthma maintenance therapy and over-using rescue medications [ 4 , 37 – 39 ] and both have been identified as contributory risk factors for asthma deaths [ 38 ]. The problem of non-adherence is also significant in more severe disease.…”

Treatment patterns among non-active users of maintenance asthma medication in the United Kingdom: a retrospective cohort study in the Clinical Practice Research Datalink

“…Whilst a strength of the current study was that it clearly demonstrated intermittent treatment patterns in a longitudinal design, these data could not determine how patients were taking their prescribed maintenance therapyfor example, whether they underused and stockpiled medicationonly that there were periods of prescription absences. As suggested by other surveys (23)(24)(25), patients may have been using their medication irregularly over an extended period of time, stopping and starting their treatment when their symptoms felt better or worse, respectively.…”

“…Similarly, in the pan-European REALIZE online survey, of the respondents who stated that they had a maintenance therapy inhaler (n ¼ 3,481), over half did not use it every day as prescribed (24). The latest results of the European Community Respiratory Health Survey (ECRHS III) showed that whilst there has been an increase in the use of asthma medication in the last 20 years, only 34% of subjects with persistent asthma were taking ICS on a regular basis (25). This irregular use of maintenance therapies has clinical consequences.…”

Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark

“…The present trial will provide evidence of the effectiveness of the BrEX programme in patients with incomplete asthma control despite attending specialist care and adhering to moderate to high doses inhaled corticosteroids (ICS) with/without a second controller (GINA steps 3–5) 2. Asthma control is not obtained in the majority of patients,14 75 76 and new measures to improve patients’ daily life with asthma are needed. The trial results will add pivotal information to future evidence-based guidelines and clinical practice.…”