How well controlled is asthma in people on daily inhalers?
Most people taking daily preventer inhalers still had poorly controlled asthma, and when symptoms worsened they reached for their rescue inhaler first and increased their preventer only late.
Source
Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study
Study at a glance
- Design
- Cross-sectional — Multinational telephone survey using a structured questionnaire and the Asthma Control Questionnaire; patients recruited through their primary-care physicians and specialists.
- N
- N=3415 · 3,415 patients completed full interviews out of 3,893 enrolled, across 11 countries.
- Population
- Adults and adolescents aged 16 or older with physician-diagnosed asthma prescribed daily inhaled corticosteroid maintenance therapy, with or without a long-acting β2-agonist, in Europe, North America and Australia.
- Outcome
- Asthma control (ACQ score), frequency of worsenings, unscheduled medical care, how patients adjusted medication during worsenings, and attitudes to self-management.
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
Physicians in 11 countries asked consecutive adult asthma patients on regular inhaled corticosteroids (alone or combined with a long-acting bronchodilator) to take part in a 30-minute structured telephone interview. Patients reported their medication use, worsenings and unplanned medical care over the past year, their own view of their control, and their attitudes to managing asthma. Control was also scored with a validated tool, the Asthma Control Questionnaire.
What they found
By questionnaire score, only 28% had well-controlled asthma and 51% were uncontrolled, yet most patients with uncontrolled asthma still described their control as relatively good. In the week before the interview, 74% used their rescue inhaler every day, 51% had needed unplanned medical care in the past year, and 89% reported worsenings, averaging about 12 a year. During worsenings patients increased their rescue (short-acting β2-agonist) inhaler first and raised their inhaled steroid only later and less, even though 52% said they stepped up their maintenance dose on their own. Most patients felt confident self-managing and preferred adjusting their medication to how their asthma felt.
The limits
What it doesn't show
All data are self-reported by telephone, so medication use, worsenings and hospital visits could be misremembered, and there is no objective lung-function measurement. Patients were recruited through recent clinic visits, which may exclude people with poor access to care and may over-represent more severe disease; some may have had undiagnosed COPD. As a one-off survey, it describes behaviour but cannot show that adjusting inhaled steroids earlier would improve control. The study was sponsored with involvement from a drug manufacturer and conducted by a market-research agency.
Key terms
- Inhaled corticosteroid (ICS)
- A 'preventer' inhaler that reduces airway inflammation and is taken daily in persistent asthma.
- Long-acting β2-agonist (LABA)
- A bronchodilator with a long duration of action; added to an ICS for patients who remain symptomatic.
- Short-acting β2-agonist (SABA)
- A quick-relief 'rescue' inhaler used to ease symptoms immediately; frequent use signals poor control.
- Asthma Control Questionnaire (ACQ)
- A validated questionnaire scoring symptoms and rescue-medication use over the past week; lower scores mean better control.
- Asthma worsening
- In this study, an occasion when a patient's symptoms became bothersome or limiting.
Flashcards
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Quiz yourself
What medications were all included patients prescribed?
Common questions
Why does it matter that patients increase their rescue inhaler before their steroid inhaler?
The rescue inhaler relieves symptoms but does not treat the underlying inflammation. Raising the anti-inflammatory steroid early in a worsening might stop it escalating, so relying on the rescue inhaler first may be a missed opportunity.
How can patients think their asthma is controlled when a questionnaire says it isn't?
Many patients seem to accept frequent symptoms and daily rescue-inhaler use as normal, so their expectations of 'good control' are lower than guideline targets.
What do the authors recommend?
Patient-centred education with a written personal action plan that tells patients how and when to adjust their maintenance medication during worsenings.
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