What Patients Call Their Inhalers Is Associated with "Asthma Attacks"

Victoria E Forth¹, Juan Carlos Cardet¹, Ku-Lang Chang¹, Brianna Ericson¹, Laura P Hurley¹, Nancy E Maher¹, Elizabeth W Staton¹, Bonnie Telón Sosa¹, Elliot Israel²; PREPARE investigators

Affiliations

¹ From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO).
² From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO). eisrael@bwh.harvard.edu.

PMID: 37468217
DOI: 10.3122/jabfm.2022.220270R2

Free article

What Patients Call Their Inhalers Is Associated with "Asthma Attacks"

Victoria E Forth et al. J Am Board Fam Med. 2023.

Free article

. 2023 Aug 9;36(4):650-661.

doi: 10.3122/jabfm.2022.220270R2. Epub 2023 Jul 19.

Authors

Victoria E Forth¹, Juan Carlos Cardet¹, Ku-Lang Chang¹, Brianna Ericson¹, Laura P Hurley¹, Nancy E Maher¹, Elizabeth W Staton¹, Bonnie Telón Sosa¹, Elliot Israel²; PREPARE investigators

Affiliations

¹ From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO).
² From the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (VEF, BE, NEM, EI, PAH, JK, JRL, JC, JDS); Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL (JCC); Denver Health and Hospital Authority, Denver, CO (LPH); Lucas Research, Morehead City, NC (KLC); American Academy of Family Physicians National Research Network, Leawood, KS (EWS, JKC, BKM, WDP, JBS); University of Colorado Department of Family Medicine, Aurora, CO (EWS, JKC); Department of Internal Medicine, Allergy/Immunology Section, University of Puerto Rico, San Juan, PR (BTS); Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA (EI); Pulmonary Science and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO (ALF); DARTNet Institute, Aurora, CO (WDP); Division of Immunology, Boston Children's Hospital, Boston, MA (WP); University of Miami Health System, Miami, FL (MF); Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Glenview, IL (GM); Morehouse School of Medicine, Atlanta, GA (FO). eisrael@bwh.harvard.edu.

PMID: 37468217
DOI: 10.3122/jabfm.2022.220270R2

Abstract

Background: Clinician-patient miscommunication contributes to worse asthma outcomes. What patients call their asthma inhalers and its relationship with asthma morbidity are unknown.

Methods: Inhaler names were ascertained from Black and Latinx adults with moderate-severe asthma and categorized as "standard" if based on brand/generic name or inhaler type (i.e., controller vs. rescue) or "non-standard" for other terms (i.e., color, device type, e.g., "puffer," or unique names). Clinical characteristics and asthma morbidity measures were evaluated at baseline: self-reported asthma exacerbations one year before enrollment (i.e., systemic corticosteroid bursts, emergency department (ED)/urgent care (UC) visits, or hospitalizations), and asthma control and quality of life. Multivariable regression models tested the relationship between non-standard names and asthma morbidity measures, with adjustments.

Results: Forty-four percent (502/1150) of participants used non-standard inhaler names. These participants were more likely to be Black (p=0.006), from the Southeast (p<0.001), and have fewer years with asthma (p=0.012) relative to those who used standard names. Non-standard inhaler names was associated with an incidence rate ratio (IRR) of 1.29 (95% confidence interval [CI], 1.11-1.50, p=0.001; 1.8 vs. 1.5 events) for corticosteroid bursts for asthma, an IRR=1.43 (95% CI, 1.21-1.69, p<0.001; 1.9 vs. 1.4 events) for ED/UC visits for asthma, and an odds ratio=1.57 (95% CI, 1.12-2.18, p=0.008; 0.5 vs. 0.3 events) for asthma hospitalizations after adjustment.

Conclusions: Patients who use non-standard names for asthma inhalers experience increased asthma morbidity. Ascertaining what patients call their inhalers may be a quick method to identify those at higher risk of poor outcomes.

Trial registration: ClinicalTrials.gov NCT02995733.

Keywords: Asthma; Health Literacy; Inhalers; Outcomes Assessment; Physician-Patient Relations.

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Conflict of interest statement

Conflict of interest: Ms. Forth reports receiving honoraria from Takeda for work in advisory boards for Alpha 1 antitrypsin and severe COPD. Dr. Cardet reports receiving honoraria from AstraZeneca, Genentech, and GSK for work in advisory boards and educational lectures on asthma. Dr. Fuhlbrigge is an unpaid consultant to AstraZeneca for the development of outcome measures for asthma and COPD clinical trials and a consultant to Novartis on epidemiologic analyses related to asthma control. Dr. Pace has received research grants from and is a consultant for Boehringer Ingelheim and a research grant from AstraZeneca. Dr. Phipatanakul received grants from Genentech, Regeneron, Novartis, Sanofi, Merck, and GSK; consulting fees from Regeneron, Sanofi, GSK, Genentech, and Novartis; and honoraria for educational events from Genentech, Sanofi, Regeneron, and GSK. Dr. Mosnaim received research grant support from AstraZeneca, Alk-Abello and Genentech and receives research grant support from GlaxoSmithKline, Novartis, Sanofi-Regeneron, and TEVA. Dr. Israel received in-kind medications or devices for NIH or PCORI-sponsored studies from Teva, Circassia, royalties from UpToDate, and consulting fees from AB Science, Allergy and Asthma Network, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Avillion, Biometry, Equillium, Genentech, GlaxoSmithKline, Merck, NHLBI, Novartis, Pneuma Respiratory, PPS Health, Regeneron, Sanofi Genzyme, Sienna Biopharmaceuticals, TEVA, and Cowen. The other authors have no conflicts of interest to disclose.

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What Patients Call Their Inhalers Is Associated with "Asthma Attacks"

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What Patients Call Their Inhalers Is Associated with "Asthma Attacks"

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