Effectiveness of Same Versus Mixed Asthma Inhaler Devices: A Retrospective Observational Study in Primary Care

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.

Practice appointment rates for high-risk asthmatics: what could be the predictor[s]?

Practice appointment rates could have a significant impact on national health care costs and services offered by doctors. In this respect a study was designed to determine the relationship between practice appointments and possible predictors in high-risk asthmatics. An observational retrospective analysis of the predictors for the practice appointments in asthmatic patients with at least one hospital admission between years 1994-1998 was carried out. This study was performed in a local district general hospital and consenting practices in the UK. 115 asthmatics, aged over 5 years, admitted to the hospital for asthma exacerbations, between years 1994-1998, were enrolled in the study. Multivariate ridge regression was used to build the final model. Analysis revealed that the predictors age and the number of prednisolone rescue courses could remain in the final model [p=0.002, r=0.46]. As a conclusion, frequent oral steroid users and elderly asthmatics were found to have higher practice appointment rates. This is highly likely due to a more severe asthma condition as well as age-related problems in these groups of patients. These findings represent the importance of asthma management in unstable asthmatics and elderly patients in primary care level