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Randomized Controlled Trial
. 2008 Jan;58(546):37-43.
doi: 10.3399/bjgp08X263802.

Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?

Milind P Sovani  1 , Christopher I Whale, Janet Oborne, Sue Cooper, Kevin Mortimer, Tommy Ekström, Anne E Tattersfield, Timothy W Harrison
Affiliations
Randomized Controlled Trial

Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?

Milind P Sovani et al. Br J Gen Pract. 2008 Jan.

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 beta(2)-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 microg one puff twice daily plus their own short-acting beta(2)-agonist as required (control group), or budesonide/formoterol 200/6 microg 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 microg/day, mean difference 196 mug, 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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Figures

Figure 1
Figure 1
Flow chart showing stepwise participant selection and reasons for exclusions.
Figure 2
Figure 2
Range of mean daily budesonide dose during the 6-month study. (a) Control group; (b) active group.
Appendix 1
Appendix 1
Mean change in Forced expiratory volume in 1 second (FEV1) over the 6-month study period. (a) Control group; (b) active group.
See this image and copyright information in PMC

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