An increase in asthma-related morbidity and mortality has been reported recently, resulting in a substantial increase in the economic impact of this condition. Little information is available relating to the costs of asthma depending on the degree of severity of the disease. Total, direct and indirect costs generated by asthma patients who sought medical care for asthma control over a one-year period in a northern area of Spain were determined. Data were obtained from the patients themselves and severity of illness was classified into mild, moderate and severe according to the International Consensus Report on Diagnosis and Treatment of Asthma, 1992. The average total annual asthma-derived cost was estimated at US$2,879 per patient, with averages of US$1,336 in mildly asthmatic patients, US$2,407 in moderate asthma and US$6,393 in severe asthma. At all levels of severity, indirect costs were twice as high as direct costs, and at the same degree of severity, direct costs due to medication and hospitalization were higher among females than males. A minority of severe asthmatics incurred some 41% of the total costs. The cost of asthma was surprisingly high and varied substantially depending on the degree of severity of the disease. Further knowledge of the costs of asthma across various levels of severity will contribute to a better characterization of optimal intervention strategies for asthma care.

This study was designed to provide information on correct use and preference to features and device handling of two multidose dry powder inhalers, the Diskus/Accuhaler and the Turbuhaler. A total of 169 powder-naive patients (mean age 40 years) with asthma or chronic obstructive pulmonary disease (COPD) were enrolled in a randomized crossover comparison of both inhalers. An effective use of either inhaler was assessed before (leaflet only) and after inhaler education. Ease of use especially during an attack and the presence of a dose counter were regarded as the most important features for an ideal inhaler. The percentage of correct handling maneuvers and the percentage of patients achieving 100% of correct maneuvers increased significantly (p < 0.001) after inhaler education in both devices, but percentage of correct use after the intervention was significantly higher for the Diskus/Accuhaler (92.6%) than for the Turbuhaler (89.8%; p = 0.036). Overall 60% of patients thought the Diskus/Accuhaler was preferable to the Turbuhaler (p < 0.001). The main reasons given were presence of a dose counter, perceived ease of use including ease of learning to use, design, and attached cover. Among those who preferred the Turbuhaler device, the main reason cited was small size, discreetness, and ease of holding. In the multivariate analysis, inhaler education (p = 0.005) and education level (p = 0.009) were significantly associated with the percentage of correct maneuvers. Age, sex, or tested inhaler showed no effect on appropriateness of the inhalation technique.

Background: In the geriatric population, asthma tends to be overlooked. Moreover, typical symptoms of asthma may mimic chronic bronchitis and emphysema. Objective: To compare the characteristics of asthma between elderly (≥65 years) and adult (<65 years) asthma patients with regard to asthma severity, health-related quality of life, and direct expenditures for medical care generated by the disease. Methods: A cross-sectional study was made in the asthmatic population older than 14 years in the area of Barcelona, Spain. Asthma severity was determined according to the International Consensus criteria of 1992. St. George’s Respiratory Questionnaire (SGRQ) was used to measure the quality of life. Direct costs were calculated registering all costs generated by each patient per year. Results: The study population consisted of 282 adult asthmatics and 51 elderly asthmatics. Asthma was more severe in the elderly group (mild 10%, moderate 35%, severe 55%) than in the adult group (mild 47%, moderate 35%, severe 18%). Elderly asthmatics had significantly higher total SGRQ scores (48 vs. 35, p < 0.001) than adult asthmatics, as well as significantly higher scores for all subscales. Asthma-derived direct costs in elderly asthmatics (mean USD 1,490 vs. USD 773) were double those in adult asthmatics, mainly due to higher costs of hospitalization and medication in the elderly. Conclusions: Asthma in elderly people as compared with asthma in adulthood was more severe and was associated with a worse health-related quality of life, and significantly higher expenditures for medical care.

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The mode of administration does not influence CAT scores or its psychometric properties. Hence, both modes of administration can be used in clinical practice depending on the physician judgment of patient's capacity.