Allergy Asthma Immunol Res.  2012 Jul;4(4):184-191. 10.4168/aair.2012.4.4.184.

Effectiveness of Same Versus Mixed Asthma Inhaler Devices: A Retrospective Observational Study in Primary Care

Affiliations
  • 1Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK. david@rirl.org
  • 2Research in Real Life Ltd, Cambridge, UK.
  • 3School of Applied Sciences, University of Huddersfield, West Yorkshire, UK.
  • 4Family Physician Airways Group of Canada, Richmond Hill, ON, Canada.
  • 5Son Pisa Primary Health Care Centre, Balearic Health Service, Palma de Mallorca, Spain.
  • 6Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherland.

Abstract

PURPOSE
Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy.
METHODS
This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma).
RESULTS
Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452).
CONCLUSIONS
These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

Keyword

Asthma; breath-actuated inhaler; inhaled corticosteroids; inhaler device; pressurised metered-dose inhaler; short-acting beta2-agonist

MeSH Terms

Adrenal Cortex Hormones
Albuterol
Anti-Bacterial Agents
Asthma
Humans
Inhalation
Nebulizers and Vaporizers
Odds Ratio
Prescriptions
Primary Health Care
Respiratory System
Retrospective Studies
Adrenal Cortex Hormones
Albuterol
Anti-Bacterial Agents

Figure

  • Fig. 1 Flow diagram for selection of patient data in the General Practice Research Database

  • Fig. 2 Study endpoint results (adjusted odds ratios and rate ratios) over 1 year after the first ICS prescription for patients prescribed ICS and salbutamol via same device (n=3,428) as compared with mixed inhaler device types (n=5,452)Mixed devices: RR/OR=1.0*Adjusted for age, sex, paracetamol prescriptions, number of GP surgery consultations, number of GP out-of-hours consultations, GERD diagnosis, and time between diagnosis and the index date; **Sensitivity analysis excluded patients younger than 12 years and those prescribed >800 µg/day on the index date (same device cohort n=2,392; mixed devices cohort n=3,841). Adjusted for age, sex, number of GP home visits, number of GP out-of-hours consultations, and time between diagnosis and the index date; †Adjusted for age, asthma prescriptions, NSAID prescriptions, number of planned OPD visits, number of asthma consultations, number of GP out-of-hours consultations, number of telephone consultations, and time between diagnosis and the index date; ††Sensitivity analysis excluded patients younger than 12 years and those prescribed >800 µg/day on the index date. Adjusted for age, acute oral corticosteroids, number of primary care consultations, and time between diagnosis and the index date; ‡Adjusted for age, SES, asthma prescriptions, NSAID prescriptions, CCI score, number of primary care consultations, ICS dose at the index date, and time between diagnosis and the index date; §Adjusted for age, SES, asthma prescriptions, NSAID prescriptions, number of primary care consultations, number of planned OPD appointments, ICS dose at IPD, and time between diagnosis and the index date; ∥Adjusted for age, baseline number of asthma-related hospitalisations, number of planned OPD visits, and number of GP out-of-hours consultations.CCI, Charlson comorbidity index; GP, general practice; GERD, gastro-oesophageal reflux disease; ICS, inhaled corticosteroid; IPD, index prescription date; NSAID, nonsteroidal anti-inflammatory drug; OPD, Outpatient Department; OR, odds ratio; RR, rate ratio; SES, socioeconomic status.


Cited by  1 articles

Pharmacotherapy in the management of asthma in the elderly: a review of clinical studies
Mi-Yeong Kim, Woo-Jung Song, Sang-Heon Cho
Asia Pac Allergy. 2016;6(1):3-15.    doi: 10.5415/apallergy.2016.6.1.3.


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