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Effectiveness of same versus mixed asthma inhaler devices: a retrospective observational study in primary care.

Price D, Chrystyn H, Kaplan A, Haughney J, Román-Rodríguez M, Burden A, Chisholm A, Hillyer EV, von Ziegenweidt J, Ali M, van der Molen T - Allergy Asthma Immunol Res (2012)

Bottom Line: 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.These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

View Article: PubMed Central - PubMed

Affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.

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.

No MeSH data available.


Related in: MedlinePlus

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.
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Figure 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.

Mentions: Patients in the same device cohort were significantly more likely to achieve asthma control during the outcome year, and they experienced a significantly lower rate of severe exacerbations, than those in the mixed devices cohort (Fig. 2). Moreover, treatment success-1 was significantly more likely for patients in the same device cohort. There were no differences between cohorts in the adjusted odds for treatment success-2 or in the adjusted rate of respiratory-related hospitalisations (Fig. 2).


Effectiveness of same versus mixed asthma inhaler devices: a retrospective observational study in primary care.

Price D, Chrystyn H, Kaplan A, Haughney J, Román-Rodríguez M, Burden A, Chisholm A, Hillyer EV, von Ziegenweidt J, Ali M, van der Molen T - Allergy Asthma Immunol Res (2012)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3378924&req=5

Figure 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.
Mentions: Patients in the same device cohort were significantly more likely to achieve asthma control during the outcome year, and they experienced a significantly lower rate of severe exacerbations, than those in the mixed devices cohort (Fig. 2). Moreover, treatment success-1 was significantly more likely for patients in the same device cohort. There were no differences between cohorts in the adjusted odds for treatment success-2 or in the adjusted rate of respiratory-related hospitalisations (Fig. 2).

Bottom Line: 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.These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

View Article: PubMed Central - PubMed

Affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.

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.

No MeSH data available.


Related in: MedlinePlus