The patient-physician partnership in asthma: real-world observations associated with clinical and patient-reported outcomes

Real-world evidence generation from patients, their caregivers and physicians supporting clinical, regulatory and guideline decisions: an update on Disease Specific Programmes

OBJECTIVE

To update on and describe the role of Disease Specific Programmes (DSPs), a multi-perspective real-world data (RWD) source, in the context of the evolution of the value and acceptance of real-world evidence (RWE) in clinical, regulatory and guideline decision-making.

METHODS

DSPs are multi-national, multi-subscriber, multi-therapy cross-sectional surveys incorporating retrospective data collection from patient, caregiver and physician perspectives. Information collected covers the patient journey, including treatment/prescribing patterns and rationale, patient-reported outcomes, impact on work and everyday activities, attitudes towards and perceptions of the condition, adherence to treatment and burden of illness. Published peer-reviewed DSP papers were aligned with current key RWE themes identified in the literature, alongside their contribution to RWE.

RESULTS

RWE themes examined were: using RWE to inform clinical practice, patient and caregiver engagement, RWE role in supporting health technology assessments and regulatory submissions, informing value-driven healthcare decisions, real-world patient subgroup differences and therapeutic inertia/unmet needs; highlighting patients' and caregivers' experience of living with a disease, disconnect from their physicians, unmet needs and educational gaps.

CONCLUSIONS

DSPs provide a wealth of RWD in addition to evidence generated by registries, clinical trials and observational research, with wide use for the pharmaceutical industry, government, funding/regulatory bodies, clinical practice guideline insights and, most importantly, informing improvements in people's lives. The depth, breadth and heritage of information collected via DSPs since 1995 is unparalleled, extending understanding of how diseases are managed by physicians in routine clinical practice and why treatment choices are made, patients' perceptions of their disease management, and caregiver burden.

A novel patient-reported outcomes instrument assessing the side effects of peanut oral immunotherapy

BACKGROUND

Patients treated with peanut oral immunotherapy (OIT) may experience adverse reactions, particularly during up-dosing.

OBJECTIVE

To develop the Side Effects of Peanut Oral Immunotherapy Diary (SEPOD), an electronic questionnaire assessing the daily side effects of peanut OIT in clinical trials.

METHODS

Content and design of the SEPOD were informed by empirical literature review and meetings with 3 allergy-immunology experts. Interviews to confirm content and inform revisions were conducted in 24 pediatric patients with peanut allergy (14 treated with peanut OIT) aged 6 to 17 years; children aged 6 to 11 years were interviewed with their caregiver.

RESULTS

The SEPOD was drafted after literature review and expert interviews; the initial measurement approach comprised 2 SEPOD versions, a patient-reported outcome (PRO) version for children aged 12 to 17 years, and a caregiver-administered PRO version for children aged 6 to 11 years with instructions for caregiver questionnaire administration. Pediatric patients were expected to respond independently on both versions. Patient interviews indicated that some younger children (ie, aged 6-8 years) had difficulty understanding questions, even when reading aloud; therefore, a caregiver-administered outcome version, identical in content to the caregiver-administered PRO version, was developed for this age group. The final electronic SEPOD covered 23 peanut OIT side effects within the following 7 domains: gastrointestinal, dermatologic, itching, nasal, and respiratory, swelling (eyelid or periorbital, lip, tongue, and throat), pain (tongue, mouth, and throat), and dizziness.

CONCLUSION

This study yielded the SEPOD, a new clinical outcome assessment instrument with various methods of administration that can be used to assess the side effects of peanut OIT experienced by pediatric patients in a clinical trial setting.

Evaluating patient-perceived control of atopic dermatitis: design, validation, and scoring of the Atopic Dermatitis Control Tool (ADCT)

Objectives: The Atopic Dermatitis Control Tool (ADCT) was designed to evaluate patient-perceived AD control and facilitate patient-physician discussion on long-term disease control.Methods: The study was performed in adult patients with AD. Development of the ADCT followed US Food and Drug Administration (FDA) guidelines on patient-reported outcome measures (PROMs). Qualitative research, including targeted literature review, interviews with clinical experts, and combined concept elicitation/cognitive debriefing with patients with AD, was conducted to provide a list of comprehensive concepts capturing AD control per physician and patient perspectives. Quantitative methods assessed psychometric properties of the instrument and defined the threshold for AD control.Results: The resulting pilot six-item ADCT, reflecting key concepts related to AD control, had 7-day recall and assessed symptoms and impacts on patients' everyday lives by severity and/or frequency. The ADCT showed good content validity (well understood by adult patients with AD), and quick completion time (<2 min). Psychometric analysis indicated no floor/ceiling effects for response distributions, particularly strong (r ≥ 0.80) inter-item correlations for the six ADCT items, robust construct validity (r > 0.50), and item-level discriminating ability (p < .03); this supported the derivation of a total score based on responses to all items. ADCT total score showed evidence of strong internal consistency reliability (Cronbach's alpha >0.80). A score ≥7 points was identified as an optimum threshold to identify patients whose AD is "not in control."Conclusions: No single validated instrument has been available to holistically evaluate patient-perceived AD control. The newly developed ADCT displays good-to-excellent content validity, construct validity, internal consistency, reliability, and discriminating ability.

Adherence barriers to inhaled medicines in Japanese older patients with asthma evaluated using the "Adherence Starts with Knowledge 20" (ASK-20) questionnaire

OBJECTIVE

We investigated adherence barriers to inhaled medicines among older compared to younger adults with asthma in Japan.

METHODS

Adherence barriers to inhaled medicines were evaluated in 251 Japanese older (n = 138) and younger (n = 113) adults with asthma using the self-reporting "Adherence Starts with Knowledge 20" (ASK-20) questionnaire.

RESULTS

There were fewer older adults with poor adherence to inhaled medicines than younger adults. The ASK-20 questionnaire revealed (odds ratio [95% confidence interval]) item Q11 ("My doctor/nurse and I work together to make decisions"; 2.94 [1.31, 6.61]; p < 0.05) as an independent adherence barrier to inhaled medicines among older adults, whereas younger adults reported item Q3 ("My use of alcohol gets in the way of taking my medicines"; 3.91 [1.02 to 15.1]; p < 0.05) and item Q16 ("Taken a medicine more or less often than prescribed? "; 2.31 [1.32 to 4.06]; p < 0.05) as barriers. Older adults with poor adherence identified item Q1 ("I just forget to take my inhaled medicines some of the time"; 4.43 [1.77, 11.1]; p < 0.05) as a barrier, although the total ASK-20 scores and total barrier counts were significantly higher in older (both, p < 0.05) and younger (both, p < 0.05) adults with poor adherence than in those with good adherence.

CONCLUSION

Older Japanese patients had better adherence to inhaled medicines than younger patients. Barriers were different between older and younger adults. These results will help personalize education for inhaled medicines in Japanese asthmatics.

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

BACKGROUND

Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have reported the importance of regular follow-up visits. We investigated the effects of regular clinical visits on asthma exacerbation.

METHODS

We used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea. We included subjects aged ≥ 15 years with a diagnosis of asthma, and who were prescribed asthma-related medication, from July 2013 to June 2014. Regular visitors (frequent visitors) were defined as subjects who visited the hospital for follow-up of asthma three or more times per year.

RESULTS

Among 729,343 subjects, 496,560 (68.1%) were classified as regular visitors. Old age, male sex, lack of medical aid insurance, attendance of a tertiary hospital, a high Charlson comorbidity index, and a history of admission for exacerbated asthma in the previous year were significant determining factors for regular visitor status. When we adjusted for all these factors, frequent visitors showed a lower risk of asthma exacerbation requiring general ward admission (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.47-0.50; P < 0.001), emergency room admission (OR 0.83; 95% CI 0.79-0.86; P < 0.001), and intensive care unit admission (OR 0.49; 95% CI 0.44-0.54; P < 0.001) than infrequent visitors.

CONCLUSIONS

Regular clinical visits are significantly associated with a reduced risk of asthma exacerbation requiring hospital admission in Korean adults with asthma.

Impact of shared decision making on asthma quality of life and asthma control among children

OBJECTIVE

Few studies have examined the effectiveness of shared decision making (SDM) in clinical practice. This study evaluated the impact of SDM on quality of life and symptom control in children with asthma.

METHODS

We conducted a prospective 3-year study in six community-based practices serving a low-income patient population. Practices received training on SDM using an evidence-based toolkit. Patients aged 2-17 with a diagnosis of asthma were identified from scheduling and billing data. At approximate 6-month intervals, patients completed a survey consisting of the Mini Pediatric Asthma Quality of Life Questionnaire (range 1-7) and the control domain of the Pediatric Asthma Therapy Assessment Questionnaire (range 0-7). We used propensity scores to match 46 children receiving SDM to 46 children receiving usual care with decision support. Included children had completed a baseline survey and at least one follow-up survey. Random coefficient models incorporated repeated measures to assess the effect of SDM on asthma quality of life and asthma control.

RESULTS

The sample was primarily of non-White patients (94.6%) with Medicaid insurance (92.4%). Receipt of SDM using an evidence-based toolkit was associated with higher asthma quality of life [mean difference 0.9; 95% confidence interval (CI) 0.4-1.4] and fewer asthma control problems (mean difference -0.9; 95% CI -1.6--0.2) compared to usual care with decision support.

CONCLUSIONS

Implementation of SDM within clinical practices using a standardized toolkit is associated with improved asthma quality of life and asthma control for low-income children with asthma when compared to usual care with decision support.

Pulmonary deposition of fluticasone propionate/formoterol in healthy volunteers, asthmatics and COPD patients with a novel breath-triggered inhaler

INTRODUCTION

A combination of fluticasone propionate/formoterol fumarate (FP/FORM) has been incorporated within a novel, breath-triggered device, named K-haler^®. This low resistance device requires a gentle inspiratory effort to actuate it, triggering at an inspiratory flow rate of approximately 30 L/min; thus avoiding the need for coordination of inhalation with manual canister depression. The aim of the study was to evaluate total and regional pulmonary deposition of FP/FORM when administered via the K-haler device.

MATERIALS AND METHODS

Twelve healthy subjects, 12 asthmatics, and 12 COPD patients each received a single dose of 2 puffs ^99mtechnetium-labelled FP/FORM 125/5 μg. A gamma camera was used to obtain anterior and posterior two-dimensional images of drug deposition. Prior transmission scans (using a^99mtechnetium flood source) allowed the definition of regions of interest and calculation of attenuation correction factors. Image analysis was performed per standardised methods.

RESULTS

Of 36 subjects, 35 provided evaluable post-dose scintigraphic data. Mean subject ages were 35.7 (healthy), 44.5 (asthma) and 61.7 years (COPD); mean FEV₁% predicted values were 109.8%, 77.4% and 43.2%, respectively. Mean pulmonary deposition was 26.6% (healthy), 44.7% (asthma), 39.0% (COPD) of the delivered dose. The respective mean penetration indices (peripheral:central ratio normalised to a transmission lung scan) were 0.44, 0.31 and 0.30.

CONCLUSION

FP/FORM administration via the K-haler device resulted in high lung deposition in patients with obstructive lung disease but somewhat lesser deposition in healthy subjects. Regional deposition data demonstrated drug deposition in both the central and peripheral regions in all subject populations.

EUDRACT NUMBER

2015-000744-42.

A Randomized, Crossover Trial Evaluating Patient Handling, Preference, and Ease of Use of the Fluticasone Propionate/Formoterol Breath-Triggered Inhaler

BACKGROUND

Appropriate inhaler selection is of fundamental importance in obstructive lung disease management. Key factors in device selection include a patient's capacity to operate a particular device and their preference for it.

METHODS

This randomized, open-label, two-period, crossover study (NCT01739387) compared the ability of adolescent and adult patients with obstructive lung disease to correctly handle the fluticasone propionate/formoterol fumarate (FP/FORM; Flutiform^®) pressurized metered-dose inhaler (pMDI) and FP/FORM K-haler^®, a novel breath-triggered inhaler (BTI), following a simple, standardized training regimen. The primary endpoint was the ability to perform all steps correctly at the first attempt. Secondary endpoints included the ability to perform all critical steps correctly at the first attempt, the requisite number of attempts to successfully use the inhaler, the ability to be trained within 15 minutes, and the ability to trigger the K-haler BTI to actuate at the first attempt. Ease of device use and device preference versus patients' usual maintenance inhalers were also assessed.

RESULTS AND CONCLUSIONS

At the first attempt, an identical proportion (77.2% [95% confidence interval [CI]: 72.1, 81.8]) of 307 patients performed all pMDI and K-haler BTI handling steps correctly, whereas the corresponding proportions performing all critical steps correctly were 82.4% (95% CIs: 77.7, 86.5) and 87.0% (95% CI: 82.7, 90.5), respectively. For both devices, >90% of patients required only two attempts to master device usage; >99% of patients could be trained to correctly use each device within 15 minutes. Virtually all patients (99.0% [95% CIs: 97.2, 99.8]) were able to successfully trigger the K-haler BTI's dose-release mechanism at first attempt. Ease of use and preference data for FP/FORM pMDI challenged the perceived wisdom that dry powder inhalers are necessarily simpler to use, whereas the corresponding data for FP/FORM K-haler strongly favored this novel BTI over the Turbuhaler^®, Accuhaler^®, and other pMDIs.

Validation of the Polish version of Satisfaction with Asthma Treatment Questionnaire (SATQ)

INTRODUCTION

Among the chronically ill there is a tendency for non-compliance with medical recommendations, which is often due to low satisfaction with the offered treatment. Satisfaction with Asthma Treatment Questionnaire (SATQ) is a questionnaire for measuring satisfaction with the inhalation treatment of asthma in patients of more than 18 years of age. SATQ is a standardized tool that has not been previously used in Poland. SATQ consists of 4 domains: efficiency, ease of use, the burdening with asthma treatment and side effects and concerns.

AIM

To validate the Polish language version of SATQ questionnaire and an overall verification of the usefulness of the tool relative to trials from clinical practice.

MATERIAL AND METHODS

The degree of difficulty and comprehension of the questions and the reliability and validity of the Polish version of the questionnaire was determined in 67 patients with asthma (mean age: 45.8 ±14.3 years (range maximum - at least 18-65 years). The vast majority of patients in the study group have used the inhalers for more than 1 year and were educated in the field of aerosols management. The resulting scores are calculated by adding up the scores for each question and dividing by the number of questions. The reliability of the questionnaire design was verified using the Spearman rank correlation coefficients between elements and ranges between band assessments and evaluations and overall assessment of quality and patient satisfaction with treatment. Internal consistency and reliability of the tool was assessed using Cronbach's α. The values of Cronbach's α were evaluated with respect to the threshold value of 0.70.

RESULTS

SATQ questionnaire was understandable and easy to fill out for all subjects. The filling time of SATQ was designed as to be within 5-10 min. Cronbach's α was reached on all scales, demonstrating the reliability of the analyzed scale and lack of redundancy.

CONCLUSIONS

The Polish version of SATQ questionnaire meets the basic psychometric criteria and can be used to assess satisfaction with the inhalation treatment of asthma.

Cross-reactivity between aeroallergens and food allergens

In patients with respiratory allergy, cross-reactivity between aeroallergens and foods may induce food allergy, symptoms ranging from oral allergy syndrome to severe anaphylaxis. Clinical entities due to IgE sensitization to cross-reactive aeroallergen and food allergen components are described for many sources of plant origin (pollen-food syndromes and associations, such as birch-apple, cypress-peach and celery-mugwort-spice syndromes, and mugwort-peach, mugwort-chamomile, mugwort-mustard, ragweed-melon-banana, goosefoot-melon associations), fungal origin (Alternaria-spinach syndrome), and invertebrate, mammalian or avian origin (mite-shrimp, cat-pork, and bird-egg syndromes). Clinical cases of allergic reactions to ingestion of food products containing pollen grains of specific plants, in patients with respiratory allergy to Asteraceae pollen, especially mugwort and ragweed, are also mentioned, for honey, royal jelly and bee polen dietary supplements, along with allergic reactions to foods contaminated with mites or fungi in patients with respiratory allergy to these aeroallergens. Medical history and diagnosis approach may be guided by the knowledge about the diverse cross-reacting allergens involved, and by the understanding of these clinical entities which may vary significantly or may be overlapping. The association between primary IgE sensitization with respiratory symptoms to inhaled allergens and food allergy due to cross-reactive allergen components is important to assess in allergy practice. The use of molecular-based diagnosis improves the understanding of clinically relevant IgE sensitization to cross-reactive allergen components from aeroallergen sources and foods.

Real-world disparities between patient- and clinician-reported outcomes: results from a disease-specific program in depression and anxiety

PURPOSE

The purpose of this study was to identify potential discordance between physician and patient rated measures of depression used by primary care physicians and psychiatrists.

PRIMARY PRACTICE SETTING

This study collected data from primary care physicians and psychiatrists in the United States between October and December 2009.

METHODOLOGY AND SAMPLE

A real-world, cross-sectional study was conducted using the Neuroses Disease-Specific Programme (Adelphi Real World, Macclesfield, United Kingdom). Treatment practice data were collected by 180 physicians (100 primary care and 80 psychiatrists) who were asked to provide information for the next 15 outpatients presenting prospectively with symptoms of anxiety and/or depression (n = 2,704 patients). The primary outcome measures were the Clinical Global Impressions-and Patient Global Impressions-Improvement scales, completed by both physicians and their matched patients, respectively. Cohen's kappa coefficient (κ) was calculated to assess the level of agreement between the Clinical Global Impressions-and Patient Global Impressions-Improvement scale responses.

RESULTS

Physician- and patient-rated overall improvement in illness was 82% and 89%, respectively. Results of the kappa analysis demonstrated fair agreement between patients and physicians regarding overall improvement in illness (44% agreement; κ= 0.23). Physician ratings of patient improvement progressively decreased with increased severity of illness.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

These real-world data suggest that the degree of reduction in symptoms of anxiety and/or depression may be estimated differently by physicians when compared with their patients. Understanding the potential for disparities between physician- and patient-rated measures in reviewing patient care, particularly in patients with more severe depressive symptoms, can help ensure that treatment plans are aligned with patient needs.

Continuing discrepancy between patient perception of asthma control and real-world symptoms: a quantitative online survey of 1,083 adults with asthma from the UK

Background:

Previous studies have identified a discrepancy between patient perception of asthma control and real-world symptoms; despite several hypotheses, the reasons remain unclear.

Aims:

To explore patients' experiences of asthma symptoms and disease management and their educational needs in the UK; to assess recent progress in asthma control and management.

Methods:

A quantitative questionnaire-based online survey of UK patients aged ≥18 years with self-reported asthma.

Results:

Of the 1,083 individuals (55% female, 49% aged ≥55 years) who completed the survey, 79% described their asthma control as ‘good’ or ‘very good’. Despite this, in the previous 2 years, 65% had experienced ‘frequent’ day-time symptoms, 37% had ‘frequent’ night-time symptoms, and 25% had used oral steroids for asthma; 41% of those prescribed a reliever inhaler used it ≥1 a day. Overall, 76% had a ‘good’ or ‘very good’ relationship with their healthcare professional (HCP); 32% had not attended regular asthma reviews and only 12% were using a personal asthma action plan. Moreover, 70% of respondents felt that they had the ‘main responsibility’ for managing their asthma; 29% believed this responsibility to be shared with their HCP.

Conclusions:

This survey indicates a continuing discrepancy between patient perception of asthma control and real-world symptoms, with little change from previous studies. Many patients accept symptoms as the norm. The diversity among respondents' attitudes demonstrates a need to help patients change some of their beliefs and understanding about asthma, and to improve asthma management with better education about the understanding of control for patients and HCPs.

Timing of emergency department visits for childhood asthma after initial inhaled corticosteroid use

Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICS-Rx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits. Population Health Management 2015;18:54-60.

Potential negative consequences of non-consented switch of inhaled medications and devices in asthma patients

BACKGROUND

Asthma requires individually tailored and careful management to control and prevent symptoms and exacerbations. Selection of the most appropriate treatment is dependent on both the choice of drugs and inhaler device; however, financial pressures may result in patients being switched to alternative medications and devices in an attempt to reduce costs.

AIM

This review aimed to examine the published literature in order to ascertain whether switching a patient's asthma medications or device negatively impacts clinical and economic outcomes.

MATERIALS AND METHODS

A literature search of MEDLINE (2001-13 September 2011) was conducted to identify English-language articles focused on the direct impact of switching medications and inhaler devices and switching from fixed-dose combination to monocomponent therapy via separate inhalers in patients with asthma; the indirect impacts of switching were also assessed.

RESULTS

Evidence showed that non-consented switching of medications and inhalers in patients with asthma can be associated with a range of negative outcomes, at both individual and organisational levels. Factors that reduce adherence may lead to compromised symptom control resulting in increased healthcare resource utilisation and poorer patient quality of life.

DISCUSSION

The consequences of a non-consented switch should be weighed carefully against arguments supporting an inhaler switch without the patient's consent for non-medical/budgetary reasons, such as potential reductions in initial acquisition costs, which may be associated with subsequent additional healthcare needs.

CONCLUSION

Given the increasing pressure for reduced costs and efficient allocation of limited healthcare resources, an additional investment in ensuring high medication adherence may lead to greater savings due to a potentially decreased demand for healthcare services. In contrast, savings achieved in acquisition costs may result in a greater net loss due to increased healthcare consumption caused by decreased asthma control.

Asthma action plans and patient satisfaction among women with asthma

BACKGROUND

Asthma action plans (AAPs) are a priority recommendation of the National Asthma Education and Prevention Program and have been shown to positively affect health outcomes. Patient satisfaction is an important clinical outcome, yet little is known about its association with receiving an AAP. This study examined the association between having an AAP and behaviors to keep asthma in control and patient satisfaction with care.

METHODS

The study design was a cross-sectional analysis of baseline data from a randomized trial evaluating a self-management program among 808 women with asthma. Participants reported demographic information, interactions with clinicians, whether they had an AAP and owned a peak flow meter, self-management behaviors, and symptoms.

RESULTS

The mean age of the participants was 48 ±13.6 years, 84% (n= 670) were satisfied with their asthma care, and 48% (n= 383) had a written AAP from their physician. Women not having an AAP were less likely to take asthma medication as prescribed [ x 2 (1) = 13.68, P , .001], to initiate a discussion about asthma with their physicians [ x 2 (1) = 26.35, P < .001], and to own a peak fl ow meter [ x 2 (1) =77.84, P < .001]. Adjusting for asthma control, income, and medical specialty,women who did not have an AAP were more likely to report dissatisfaction with their asthma care (OR, 2.07; 95% CI, 1.35-3.17; P < .001).

CONCLUSIONS

Women without an AAP were less likely to initiate discussions with their physicians,take medications as prescribed, and own a peak fl ow meter to monitor asthma, all considered important self-management behaviors. They were also less satisfied with their care. Not having an AAP may affect interactions between patient and physician and clinical outcomes.

Asthma in Head Start children: effects of the Breathmobile program and family communication on asthma outcomes

BACKGROUND

Asthma morbidity and mortality rates are high among young inner-city children. Lack of routine primary care provider visits, poor access to care, and poor patient-physician communication might be contributing factors.

OBJECTIVE

This study evaluated the effects of providing Breathmobile services only, a Facilitated Asthma Communication Intervention (FACI) only, or both Breathmobile plus FACI on asthma outcomes relative to standard care.

METHODS

Children with asthma (n = 322; mean age, 4 years; 53% male; 97% African American) were recruited from Head Start programs in Baltimore City and randomized into 4 groups. Outcome measures included symptom-free days (SFDs), urgent care use (emergency department visits and hospitalizations), and medication use (courses of oral steroids and proportion taking an asthma controller medication), as reported by caregivers at baseline, 6-month, and 12-month assessments. Generalized estimating equations models were conducted to examine the differential treatment effects of the Breathmobile and FACI compared with standard care.

RESULTS

Children in the combined treatment group (Breathmobile plus FACI) had an increase of 1.7 (6.6%) SFDs that was not maintained at 12 months. In intent-to-treat analyses the FACI-only group had an increase in the number of emergency department visits at 6 months, which was not present at 12 months or in the post hoc as-treated analyses. No significant differences were found between the intervention groups compared with those receiving standard care on all other outcome measures.

CONCLUSIONS

Other than a slight improvement in SFDs at 6 months in the Breathmobile plus FACI group, the intervention components did not result in any significant improvements in asthma management or asthma morbidity.

Importance of inhaler-device satisfaction in asthma treatment: real-world observations of physician-observed compliance and clinical/patient-reported outcomes

INTRODUCTION

It is hypothesized that health and patient-reported outcomes in asthma are positively influenced by the level of patient satisfaction with their inhaler device. This paper uses data from a real-world observational study to investigate the extent of the relationship between inhaler satisfaction and patient compliance, and the influence this has on health and patient-reported outcomes.

METHODS

Data were drawn from the Adelphi Respiratory Disease Specific Programme® (Adelphi, Macclesfield, UK), a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of these and their relationship with patient-reported inhaler satisfaction and patient compliance.

RESULTS

The analysis demonstrates that for the majority of patients the higher the level of satisfaction that the patient reports for their device the more likely the patient is observed to be compliant and to experience better outcomes including quality of life (as measured by EuroQol 5 Dimensions [EQ-5D] utility score, P<0.001), fewer exacerbations (P<0.001), fewer hospital visits (P=0.011), fewer healthcare visits (P=0.001), fewer primary care physician visits (P=0.001), and fewer sleep disturbances (P<0.001).

CONCLUSION

The level of patient satisfaction with their inhaler device is observed to have a positive influence on the treatment goals for asthma through its association with improved compliance.