Satisfaction levels and asthma control amongst Malaysian asthmatic patients on budesonide/formoterol maintenance and reliever therapy: experience in a real-life setting

Abstract

Background: Budesonide/formoterol used for both maintenance and reliever therapy has been shown to benefit patients with persistent asthma. We evaluated patient satisfaction and asthma control among Malaysian patients prescribed budesonide/formoterol as single maintenance and reliever therapy in a real-life clinical practice.

Methods: Adult patients diagnosed with partially controlled or uncontrolled asthma were recruited in a 6-month, prospective, open-label study involving ten hospital-based chest clinics in Malaysia. Patients were prescribed one or two inhalations of budesonide/formoterol Turbuhaler (160/4.5 μg per inhalation) twice daily as maintenance therapy and additional inhalation as reliever therapy. Maintenance doses were decided by physicians based on Global Initiative for Asthma-defined treatment objectives. The primary outcome measure was the change in mean Satisfaction with Asthma Treatment Questionnaire (SATQ) scores from baseline to an average of 3 months and 6 months. Secondary outcome was the change in mean Asthma Control Questionnaire 5-item version (ACQ-5) scores from baseline to an average of 3 months and 6 months and the proportion of patients achieving the minimum clinically important difference.

Results: Of 201 eligible patients recruited, 195 completed the study. Overall, SATQ mean (standard deviation) score was significantly improved from 5.1 (0.76) at baseline to 5.5 (0.58) (P < 0.001). The increase was observed in all domains of SATQ and had occurred at 3 months for most patients. ACQ-5 mean (standard deviation) score was significantly reduced from 2.2 (1.13) at baseline to 1.2 (0.95) (P < 0.001). A total of 132 (67.7.1%) patients had achieved the minimal clinically important difference (≥0.5) of ACQ-5 scores at study end.

Conclusion: In a nationwide study, budesonide/formoterol maintenance and reliever therapy achieved greater patient satisfaction and better asthma control compared with previous conventional asthma regimes among Malaysian patients treated in a real-life practice setting. Such an approach may represent an important treatment alternative for our local patients with persistent asthma.

Keywords: Malaysia; Symbicort; asthma; asthma control; budesonide/formoterol; maintenance and reliever therapy; satisfaction.

Figure 1

Satisfaction with Asthma Treatment Questionnaire (SATQ) domains and mean scores at baseline and after Symbicort SMART. The mean score on Symbicort SMART is calculated from the average of 3- and 6-month scores. Notes: *P < 0.05; **P < 0.01; ***P < 0.001 vs baseline.

Figure 2

Change in SATQ overall score by pre-study asthma medication. Abbreviations: ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; SATQ, Satisfaction with Asthma Control Questionnaire.

Figure 3

Asthma Control Questionnaire (ACQ) mean scores at baseline and after Symbicort SMART. Note: ***P < 0.001 vs baseline (NB: P < 0.001 between 3 and 6 months).

Figure 4

Proportion of patients achieving minimal clinically important improvement in Asthma Control Questionnaire (ACQ) Scores, as defined by ACQ scores ≥ −0.5.

Figure 5

Change in ACQ-5 score by pre-study asthma medication. Abbreviations: ACQ-5, Asthma Control Questionnaire 5-item; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist.

Figure 6

Proportion of patients assessed by physicians as having uncontrolled, partly controlled and controlled asthma (according to Global Initiative for Asthma, GINA) at baseline and after Symbicort SMART at 3 and 6 months.

Figure 7

Proportion of patients reporting ≥1 use of their reliever medication in the preceding week. Abbreviations: SABA, short-acting β₂-agonist; prn, when required.