Abstract
BackgroundAlthough patients have more problems using metered dose inhalers, clinical comparisons suggest they provide similar control to dry powder inhalers. Using real-life situations this study was designed to evaluate asthma control in outpatients with moderate to severe persistent asthma and to compare efficacy of fixed combinations of inhaled corticosteroids (ICS) and long acting beta-agonists (LABA).MethodsThis real-life study had a cross-sectional design. Patients using fixed combinations of ICS and LABA had their asthma control and spirometry assessed during regular visits.Results111 patients were analyzed: 53 (47.7%) received maintenance therapy of extrafine beclomethasone-formoterol (BDP/F) pressurized metered dose inhaler (pMDI), 25 (22.5%) fluticasone-salmeterol (FP/S) dry powder inhaler (DPI), and 33 (29.7%) budesonide-formoterol (BUD/F) DPI. Severity of asthma at time of diagnosis, assessed by the treating physician, was comparable among groups. Asthma control was achieved by 45.9% of patients; 38.7% were partially controlled and 15.3% were uncontrolled. In the extrafine BDF/F group, asthma control total score, daytime symptom score and rescue medication use score were significantly better than those using fixed DPI combinations (5.8 ± 6.2 vs. 8.5 ± 6.8; 1.4 ± 1.8 vs. 2.3 ± 2.1; 1.8 ± 2.2 vs. 2.6 ± 2.2; p = 0.0160; p = 0.012 and p = 0.025, respectively) and the mean daily ICS dose were significantly lower.ConclusionspMDI extrafine BDP/F combination demonstrated better asthma control compared to DPIs formulated with larger particles. This could be due to the improved lung deposition of the dose or less reliance on the optimal inhalation technique or both.
Highlights
Patients have more problems using metered dose inhalers, clinical comparisons suggest they provide similar control to dry powder inhalers
Male and female asthma patients aged above 18 years were eligible for inclusion in the study if: 1) they had a diagnosis of moderate or severe persistent asthma confirmed by chest physician; 2) diagnosis occurred at least 6 months before the beginning of the study; 3) they were treated with fixed combination of inhaled corticosteroids (ICS) and long acting beta-agonists (LABA) as maintenance therapy; 4) they did not change their medication within the last 4 weeks prior to start of study; 5) they had no asthmatic exacerbation within the last 6 weeks prior to start of study
For the purpose of the study, patients were divided in two groups depending on the inhaler device they were using
Summary
Patients have more problems using metered dose inhalers, clinical comparisons suggest they provide similar control to dry powder inhalers. Efficacy results reported in RCTs are often inconsistent with data observed in real-life settings where asthma control still remains an unmet need for the great majority of patients [1,4]. RCTs are performed under highly controlled settings and in selected populations of patients. Under these controlled conditions, good inhalation technique is usually checked and granted and the importance of compliance is emphasized. Good inhalation technique is usually checked and granted and the importance of compliance is emphasized Such a level of adherence is not to be expected in real-life settings. Among the several identified reasons, wrong diagnosis, smoking, co-morbidities, individual variation in response to treatment, poor adherence, and poor inhalation technique have been described
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