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

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.

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

Document Type: Research article

DOI: http://dx.doi.org/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

Publication date: 2008-01-01

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• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.

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