Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study

Abstract

Background: This study examined the attitudes and actions of 3415 physician-recruited adults aged > or = 16 years with asthma in eleven countries who were prescribed regular maintenance therapy with inhaled corticosteroids or inhaled corticosteroids plus long-acting beta2-agonists.

Methods: Structured interviews were conducted to assess medication use, asthma control, and patients' ability to recognise and self-manage worsening asthma.

Results: Despite being prescribed regular maintenance therapy, 74% of patients used short-acting beta2-agonists daily and 51% were classified by the Asthma Control Questionnaire as having uncontrolled asthma. Even patients with well-controlled asthma reported an average of 6 worsenings/year. The mean period from the onset to the peak symptoms of a worsening was 5.1 days. Although most patients recognised the early signs of worsenings, the most common response was to increase short-acting beta2-agonist use; inhaled corticosteroids were increased to a lesser extent at the peak of a worsening.

Conclusion: Previous studies of this nature have also reported considerable patient morbidity, but in those studies approximately three-quarters of patients were not receiving regular maintenance therapy and not all had a physician-confirmed diagnosis of asthma. This study shows that patients with asthma receiving regular maintenance therapy still have high levels of inadequately controlled asthma. The study also shows that patients recognise deteriorating asthma control and adjust their medication during episodes of worsening. However, they often adjust treatment in an inappropriate manner, which represents a window of missed opportunity.

Figure 1

Patient flow. *Other reasons for noncompletion included: patients did not have asthma; patients were under 16 years of age; patients used preventer only; or patients had communication difficulties.

Figure 2

The number of worsenings experienced by patients who had had ≥ 1 worsening in the last year, by level of Asthma Control Questionnaire-defined asthma control. A worsening was defined as an occasion when asthma symptoms had become bothersome or hindering in the past year. The mean number of worsenings for the total population was 11.8/year.

Figure 3

(a) Use of short-acting β₂-agonist (SABA) rescue medication and (b) use of inhaled corticosteroid (ICS) maintenance medication during the different stages of an asthma worsening. All patients used ICS plus a separate long-acting β₂-agonist (LABA), ICS alone, or a combination ICS/LABA product for regular maintenance therapy. Data are based on all patients who reported using each medication type at each particular stage.

Figure 4

Patient compliance with their regular maintenance medication when feeling well and during asthma worsenings. Definitions were as follows: Compliant Minus: using less maintenance medication than prescribed; Compliant: using maintenance medication as prescribed; Compliant Plus: using more maintenance medication than prescribed.