Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?
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)
Publisher: Royal College of General Practitioners
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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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