Treatment of moderate to severe asthma: patient perspectives on combination inhaler therapy and implications for adherence

Abstract

Symptom control in patients with moderate to severe persistent asthma is essential to reduce the significant morbidity associated with the disease. Poor adherence to controller medications has been identified as a major contributing factor to the high level of uncontrolled asthma. This review examines patient perspectives on, and preferences for, controller medications (inhaled corticosteroid and long-acting β(2)-agonist combinations [ICS/LABA]), and how this may affect adherence to therapy. Fluticasone/salmeterol and budesonide/formoterol, the currently available ICS/LABA combination products, have similar efficacy and tolerability based on a recent meta-analysis of asthma trials. Adherence is higher with the combination ICS/LABAs than when the components are administered separately. Investigations into patient preferences for desirable attributes of asthma medications indicate that an effective reliever with a fast onset and long duration of action is preferred and may lead to improved adherence. This rapid onset of effect was perceived and highly valued in patient surveys, and was associated with greater patient satisfaction. Thus, future research should be directed at therapy that offers both anti-inflammatory activity and a rapid onset of bronchodilator effect. To further improve patient adherence and treatment outcome, the effect of these characteristics as well as other factors on adherence should also be investigated.

Keywords: adherence; budesonide/formoterol; fluticasone/salmeterol; onset of effect; patient satisfaction.

Figure 1

Healthcare use and missed work/school in the past year in 809 patients with controlled asthma and 1003 patients with uncontrolled asthma. Drawn from data of Peters et al. Abbreviation: ED, emergency department.

Figure 2

Mean Patient Satisfaction with Asthma Medication (PSAM) index scores at the end of 12 weeks of treatment with budesonide/formoterol, budesonide alone, formoterol alone, or placebo. Drawn from data of Murphy et al. Abbreviations: DPI, dry powder inhaler; pMDI, pressurized metered-dose inhaler.

Figure 3

Relationship between perception of, and satisfaction with, the feeling that medication is working right away on the Onset of effect Questionnaire (OEQ) and ratings from the Patient Satisfaction with Asthma Medication (PSAM) index on satisfaction with medication and asthma symptom relief scores. Drawn from data of Murphy et al.