Effectiveness of same versus mixed asthma inhaler devices

a retrospective observational study in primary care

David Price, Henry Chrystyn, Alan Kaplan, John Haughney, Miguel Román-Rodríguez, Annie Burden, Alison Chisholm, Elizabeth V Hillyer, Julie von Ziegenweidt, Muzammil Ali, Thys van der Molen

Research output: Contribution to journalArticle

35 Citations (Scopus)
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Abstract

PURPOSE: Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy.

METHODS: This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma).

RESULTS: Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452).

CONCLUSIONS: These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

Original languageEnglish
Pages (from-to)184-191
Number of pages8
JournalAllergy, Asthma & Immunology Research
Volume4
Issue number4
Early online date6 Apr 2012
DOIs
Publication statusPublished - Jul 2012

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Nebulizers and Vaporizers
Observational Studies
Primary Health Care
Adrenal Cortex Hormones
Asthma
Retrospective Studies
Equipment and Supplies
Confidence Intervals
Metered Dose Inhalers
Albuterol
Respiratory Tract Infections
Inhalation
Prescriptions
Hospitalization
Odds Ratio
Databases
Anti-Bacterial Agents
Therapeutics

Cite this

Effectiveness of same versus mixed asthma inhaler devices : a retrospective observational study in primary care. / Price, David; Chrystyn, Henry; Kaplan, Alan; Haughney, John; Román-Rodríguez, Miguel; Burden, Annie; Chisholm, Alison; Hillyer, Elizabeth V; von Ziegenweidt, Julie; Ali, Muzammil; van der Molen, Thys.

In: Allergy, Asthma & Immunology Research, Vol. 4, No. 4, 07.2012, p. 184-191.

Research output: Contribution to journalArticle

Price, D, Chrystyn, H, Kaplan, A, Haughney, J, Román-Rodríguez, M, Burden, A, Chisholm, A, Hillyer, EV, von Ziegenweidt, J, Ali, M & van der Molen, T 2012, 'Effectiveness of same versus mixed asthma inhaler devices: a retrospective observational study in primary care', Allergy, Asthma & Immunology Research, vol. 4, no. 4, pp. 184-191. https://doi.org/10.4168/aair.2012.4.4.184
Price, David ; Chrystyn, Henry ; Kaplan, Alan ; Haughney, John ; Román-Rodríguez, Miguel ; Burden, Annie ; Chisholm, Alison ; Hillyer, Elizabeth V ; von Ziegenweidt, Julie ; Ali, Muzammil ; van der Molen, Thys. / Effectiveness of same versus mixed asthma inhaler devices : a retrospective observational study in primary care. In: Allergy, Asthma & Immunology Research. 2012 ; Vol. 4, No. 4. pp. 184-191.
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AU - Burden, Annie

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N2 - PURPOSE: Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy.METHODS: This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma).RESULTS: Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452).CONCLUSIONS: These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

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