Asthma and lower airway diseaseRandomized controlled trial of adherence with single or combination inhaled corticosteroid/long-acting β-agonist inhaler therapy in asthma
Section snippets
Subjects
Adults in the Wellington region age 16 to 65 years with a diagnosis of asthma were enrolled (Fig 1). Subjects were recruited from existing research volunteer databases, newspaper advertisements, and letters via family doctors. To be included, subjects had to have a diagnosis of asthma and to be currently taking ICS at a stable dose with or without a separate LABA inhaler. Exclusion criteria were a diagnosis of chronic obstructive pulmonary disease, current use of a combination ICS/LABA inhaler,
Results
There were 111 subjects (50 male) enrolled in the study, 54 to the separate inhaler group and 57 in the combination inhaler group. The 2 groups were well matched with regard to age, sex, baseline lung function, and asthma control (Table I). After allowing for withdrawals, complete adherence data from the final 6-week study period were available for 49 and 54 subjects in the separate and combination groups, respectively (Fig 1). Eligible participants were recruited and studied between February
Discussion
This is the first randomized controlled trial in which the effect of a combination ICS/LABA inhaler on adherence with ICS therapy has been directly measured by covert electronic monitors. It has demonstrated that although the point estimates were consistent with greater adherence with FP/salmeterol, there was no significant difference compared with FP and salmeterol prescribed in separate inhalers. Furthermore, there was no evidence of a significant difference in preferential overuse of
References (33)
- et al.
Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma
J Allergy Clin Immunol
(2003) - et al.
Improving patient compliance with asthma therapy
Respir Med
(2000) - et al.
Persistence, adherence, and effectiveness of combination therapy among adult patients with asthma
J Allergy Clin Immunol
(2006) - et al.
Improved refill persistence with fluticasone propionate and salmeterol in a single inhaler compared with other controller therapies
J Allergy Clin Immunol
(2004) - et al.
Adherence to asthma controller medication regimens
Respir Med
(2005) - et al.
Compliance of patients with asthma with an experimental aerosolized medication: implications for controlled clinical trials
J Allergy Clin Immunol
(1986) - et al.
Unpredictability of deception in compliance with physician-prescribed bronchodilator inhaler use in a clinical trial
Chest
(2000) - et al.
Adherence with montelukast or fluticasone in a long-term clinical trial: results from the mild asthma montelukast versus inhaled corticosteroid trial
J Allergy Clin Immunol
(2007) - et al.
Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma
Am J Med
(2003) - et al.
Individualized asthma self-management improves medication adherence and markers of asthma control
J Allergy Clin Immunol
(2009)
Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white
J Allergy Clin Immunol
Depressive symptoms and adherence to asthma therapy after hospital discharge
Chest
An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma
J Allergy Clin Immunol
Noncompliance and treatment failure in children with asthma
J Allergy Clin Immunol
In vitro evaluation of an asthma dosing device: the Smart-inhaler
Respir Med
Low-dose inhaled corticosteroids and the prevention of death from asthma
N Engl J Med
Cited by (0)
Supported by a research grant from GlaxoSmithKline (GSK study no. SAM106689).
The trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12606000508572.
In this article, the term adherence has been used rather than compliance because of the willing partnership between the clinician and patient in the setting of the research study.
Disclosure of potential conflict of interest: R. Beasley has received a consulting fee and research support from GlaxoSmithKline. The rest of the authors have declared that they have no conflict of interest.