Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?

Sovani, Milind; Whale, Christopher I; Oborne, Janet; Cooper, Sue; Mortimer, Kevin; Ekström, Thommy; Tattersfield, Anne E.; Harrison, Timothy

doi:10.3399/bjgp08x263802

Cited by 77 publications

(62 citation statements)

References 25 publications

(26 reference statements)

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“…The control group received budesonide (200 g, one puff twice daily) in addition to a short-acting ␤ 2 agonist as required, while the treatment group received budesonide/formoterol (200/ 6 g). Similar to Stoloff et al, 46 Sovani et al 47 also found that subjects using a single inhaler had a better adherence rate than those in the control group (80% vs 60%).…”

Section: Factors Affecting Patient Adherence To Prescribed Aerosol Thsupporting

confidence: 65%

“…They reported that subjects using fluticasone propionate and salmeterol from a single inhaler had significantly better adherence than the other groups that participated in this study. Sovani et al 47 also conducted a study to determine the effect of using a single inhaler containing a long-acting ␤ 2 agonist and a corticosteroid on subject adherence with inhaled corticosteroids. They randomized 71 subjects into control and treatment groups (35 and 36 subjects, respectively).…”

Section: Factors Affecting Patient Adherence To Prescribed Aerosol Thmentioning

confidence: 99%

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Patient Education and Adherence to Aerosol Therapy

Ari

2015

Respir Care

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SummaryNonadherence to prescribed medications results in disease instability and poor clinical control, with increases in hospital admissions, emergency room visits, school/work absenteeism, morbidity, and mortality. Poor patient adherence to therapy can be due to lack of cognition, competence, or contrivance. Patients who have not been trained or fail to understand use of drug and device combinations (cognition) often do not have the ability to use an aerosol device correctly (competence). Many patients have the competence to use the device correctly and know why they should RESPIRATORY CARE • JUNE 2015 VOL 60 NO 6 941 use the device in the way they were taught; however, they still contrive to use it in an ineffective and suboptimal manner that reduces its efficiency and effectiveness. Ensuring effective aerosol therapy and optimizing its role in disease management involve not only delivery of aerosolized medications to the lungs, but also understanding why, when, and how to use the medications, competence to use the device, motivation to adhere to therapy, and not contriving to use the device in a way that will prevent effective drug delivery. This paper explains some of the problems with patient education and adherence to aerosol therapy and suggests strategies to evaluate, monitor, and improve patient adherence effectively in primary care. Factors affecting patient adherence to prescribed medications, effective educational interventions, and strategies to promote patient adherence to aerosol therapy are also discussed.

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Section: Factors Affecting Patient Adherence To Prescribed Aerosol Thsupporting

confidence: 65%

Section: Factors Affecting Patient Adherence To Prescribed Aerosol Thmentioning

confidence: 99%

Patient Education and Adherence to Aerosol Therapy

Ari

2015

Respir Care

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“…In an open-label study among patients with low adherence and poorly controlled asthma, the use of a single inhaler containing a fixed-dose ICS/LABA for maintenance and reliever therapy was associated with increased medication use and better outcomes in patients with asthma compared to those using an ICS/LABA inhaler plus a SABA inhaler [30]. …”

Section: Implications Of Switching Devicesmentioning

confidence: 99%

The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease

Bjermer

2014

Respiration

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Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device.A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device.

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“…Combination ICS/fast-onset LABA reliever therapy allows titration of ICS therapy according to symptoms. This may increase ICS use in patients who over-rely on their SABA and are otherwise poorly adherent to maintenance ICS therapy, and may actually represent what patients, prescribed regular combination ICS/fast-onset LABA treatment, take in the "real world" [5,6]. …”

mentioning

confidence: 99%

Description of a randomised controlled trial of inhaled corticosteroid/fast-onset LABA reliever therapy in mild asthma

Beasley¹,

Pavord²,

Papi³

et al. 2016

Eur Respir J

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This paper describes the rationale and design of the Novel START (Symbicort Turbuhaler Asthma Reliever Therapy) randomised controlled trial of inhaled corticosteroid (ICS)/fast-onset long-acting β-agonist (LABA) reliever therapy in mild asthma.The main focus of clinical research and management in asthma is on patients with moderate or severe asthma. There is little attention paid to the "silent majority" with asthma who experience so-called intermittent and mild persistent asthma. These patients are often taking inhaled short-acting β-agonist (SABA) therapy alone, to provide symptom relief. However, while use of SABA therapy alone does provide symptom relief, there is little robust evidence supporting the long-term efficacy and safety of treating mild asthma with a SABA alone, or to guide clinicians and patients when to initiate regular low-dose ICS therapy. Further, doctors and patients find it difficult to recognise the need for ICS therapy when symptoms are infrequent and in this situation poor adherence to ICS is common. This has led to consideration of alternative regimens to regular ICS prescription for intermittent or mild asthma.A combination inhaler containing both an ICS and fast-onset LABA, which is used solely as reliever therapy, may be superior to SABA reliever therapy alone, and might be an alternative to regular ICS with SABA reliever therapy in patients with intermittent or mild asthma [1][2][3][4]. Combination ICS/fast-onset LABA reliever therapy allows titration of ICS therapy according to symptoms. This may increase ICS use in patients who over-rely on their SABA and are otherwise poorly adherent to maintenance ICS therapy, and may actually represent what patients, prescribed regular combination ICS/fast-onset LABA treatment, take in the "real world" [5,6].

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Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?

Cited by 77 publications

References 25 publications

Patient Education and Adherence to Aerosol Therapy

Patient Education and Adherence to Aerosol Therapy

The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease

Description of a randomised controlled trial of inhaled corticosteroid/fast-onset LABA reliever therapy in mild asthma

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