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Authors: Sovani, Milind P¹; Whale, Christopher I¹; Oborne, Janet¹; Cooper, Sue¹; Mortimer, Kevin¹; Ekström, Tommy²; Tattersfield, Anne E¹; Harrison, Timothy W³

Source: British Journal of General Practice, Volume 58, Number 546, January 2008 , pp. 37-43(7)

Abstract:

Background

Poor adherence with inhaled corticosteroids is an important problem in asthma management. Previous approaches to improving adherence have had limited success.

Aim

To determine whether treatment with a single inhaler containing a long-acting β₂-agonist and a corticosteroid for maintenance treatment and symptom relief can overcome the problem of poor adherence with inhaled corticosteroids.

Design of study

Randomised, parallel group, open-label trial.

Setting

Forty-four general practices in Nottinghamshire.

Method

Participants who used less than 70% of their prescribed dose of inhaled corticosteroid and had poorly controlled asthma were randomised to budesonide 200 μg one puff twice daily plus their own short-acting β₂-agonist as required (control group), or budesonide/formoterol 200/6 μg one puff once daily and as required (active group) for 6 months. The primary outcome was inhaled corticosteroid dose.

Results

Seventy-one participants (35 control, 36 active group) were randomised. Adherence with budesonide in the control group was approximately 60% of the prescribed dose. Participants in the active group used approximately 80% more budesonide than participants in the control group (448 versus 252 μg/day, mean difference 196 μg, 95% confidence interval 113 to 279; P<0.001) and were less likely to withdraw from the study (3 versus 13; P<0.01). No safety issues were identified.

Conclusion

Using a single inhaler for both maintenance treatment and symptom relief approximately doubled the dose of inhaled corticosteroid taken, suggesting this could be a useful strategy to overcome the problems related to poor adherence with inhaled corticosteroids.

Keywords: asthma; budesonide; formoterol; inhaled corticosteroids; patient-non-adherence

Document Type: Research article

DOI: 10.3399/bjgp08X263802

Affiliations: 1: Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital, Nottingham 2: AstraZeneca, Sweden 3: Nottingham City Hospital NHS Trust, Nottingham

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