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Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study.

Partridge MR, van der Molen T, Myrseth SE, Busse WW - BMC Pulm Med (2006)

Bottom Line: The mean period from the onset to the peak symptoms of a worsening was 5.1 days.Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Respiratory Medicine, Faculty of Medicine, Imperial College London, London, UK. m.partridge@imperial.ac.uk

ABSTRACT

Background: This study examined the attitudes and actions of 3415 physician-recruited adults aged > or = 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting beta2-agonists.

Methods: Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma.

Results: Despite being prescribed regular maintenance therapy, 74% of patients used short-acting beta2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.

Conclusion: Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

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Related in: MedlinePlus

(a) Use of short-acting β2-agonist (SABA) rescue medication and (b) use of inhaled corticosteroid (ICS) maintenance medication during the different stages of an asthma worsening. All patients used ICS plus a separate long-acting β2-agonist (LABA), ICS alone, or a combination ICS/LABA product for regular maintenance therapy. Data are based on all patients who reported using each medication type at each particular stage.
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Figure 3: (a) Use of short-acting β2-agonist (SABA) rescue medication and (b) use of inhaled corticosteroid (ICS) maintenance medication during the different stages of an asthma worsening. All patients used ICS plus a separate long-acting β2-agonist (LABA), ICS alone, or a combination ICS/LABA product for regular maintenance therapy. Data are based on all patients who reported using each medication type at each particular stage.

Mentions: Patients responded to the signs of an impending worsening by increasing their medication. Regardless of the type of maintenance therapy they were prescribed, patients reported using their SABA at the onset of symptoms, with the ICS being increased later and to a lesser extent when symptoms were at their worst (Figures 3a and 3b). A ≥ 4-fold increase in the number of SABA inhalations was reported when symptoms were at their peak compared with when patients were well. When symptoms started to decrease, patients reduced their intake of both SABA and ICS.


Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study.

Partridge MR, van der Molen T, Myrseth SE, Busse WW - BMC Pulm Med (2006)

(a) Use of short-acting β2-agonist (SABA) rescue medication and (b) use of inhaled corticosteroid (ICS) maintenance medication during the different stages of an asthma worsening. All patients used ICS plus a separate long-acting β2-agonist (LABA), ICS alone, or a combination ICS/LABA product for regular maintenance therapy. Data are based on all patients who reported using each medication type at each particular stage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1483837&req=5

Figure 3: (a) Use of short-acting β2-agonist (SABA) rescue medication and (b) use of inhaled corticosteroid (ICS) maintenance medication during the different stages of an asthma worsening. All patients used ICS plus a separate long-acting β2-agonist (LABA), ICS alone, or a combination ICS/LABA product for regular maintenance therapy. Data are based on all patients who reported using each medication type at each particular stage.
Mentions: Patients responded to the signs of an impending worsening by increasing their medication. Regardless of the type of maintenance therapy they were prescribed, patients reported using their SABA at the onset of symptoms, with the ICS being increased later and to a lesser extent when symptoms were at their worst (Figures 3a and 3b). A ≥ 4-fold increase in the number of SABA inhalations was reported when symptoms were at their peak compared with when patients were well. When symptoms started to decrease, patients reduced their intake of both SABA and ICS.

Bottom Line: The mean period from the onset to the peak symptoms of a worsening was 5.1 days.Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Respiratory Medicine, Faculty of Medicine, Imperial College London, London, UK. m.partridge@imperial.ac.uk

ABSTRACT

Background: This study examined the attitudes and actions of 3415 physician-recruited adults aged > or = 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting beta2-agonists.

Methods: Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma.

Results: Despite being prescribed regular maintenance therapy, 74% of patients used short-acting beta2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.

Conclusion: Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

Show MeSH
Related in: MedlinePlus