Patients' and physicians’ perspectives on the burden and management of asthma: Results from the APPaRENT 2 study

Canonica, Giorgio Walter; Lavoie, Kim L.; Nenasheva, N.M.; García, Gabriel; Bosnic‐Anticevich, Sinthia; Bourdin, Alain; Cano, M.C.; Abhijith, P.G.; Aggarwal, Bhumika

doi:10.1016/j.rmed.2022.106948

Cited by 18 publications

(5 citation statements)

References 26 publications

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“…Even though few studies to date have assessed the adherence to MART in the real world [ 49 ], it is unlikely that patients would be more adherent to the regular component of MART compared with regular ICS/LABA regimens. Furthermore, many patients on MART regimen request additional rescue inhalers, indicating both a perceived inadequate asthma control with this regimen and a misapplication of MART dosing in clinical practice [ 50 , 51 ]. For as-needed BUD/FOR dosing, disparate clinical trial findings [ 52 – 55 ] have resulted in non-universal adoption by different asthma treatment guidelines and health authorities, meaning that this therapeutic option currently remains off-label for many countries [ 51 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing the Effects of Changing Patterns of Inhaled Corticosteroid Dosing and Adherence with Fluticasone Furoate and Budesonide on Asthma Management

Daley‐Yates¹,

Singh

Igea³

et al. 2023

Adv Ther

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Introduction Pharmacological asthma management focuses on the use of inhaled corticosteroid (ICS)-containing therapies, which reduce airway inflammation and provide bronchoprotection, improving symptom control and reducing exacerbation risk. ICS underuse due to poor adherence is common, leading to poor clinical outcomes including increased risk of mortality. This article reviews efficacy versus systemic activity profiles for various adherence patterns and dosing regimens of fluticasone furoate (FF)-containing and budesonide (BUD)-containing asthma therapies in clinical trials and real-world studies. Methods We performed a structured literature review (1 January 2000–3 March 2022) and mathematical modelling analysis of FF-containing and BUD-containing regular daily dosing in patients with mild-to-severe asthma, as-needed BUD/formoterol (FOR) in mild asthma, and BUD/FOR maintenance and reliever therapy (MART) dosing in moderate-to-severe asthma, to assess efficacy (bronchoprotection) and systemic activity (cortisol suppression) profiles of dosing patterns of ICS use in multiple adherence scenarios. Results A total of 22 manuscripts were included in full-text review and 18 in the model simulations. Focusing on FF-containing or BUD-containing treatments at comparable adherence rates, regular daily FF or FF/vilanterol (VI) dosing provided more prolonged bronchoprotection and fewer systemic effects than daily BUD, daily BUD/FOR, or BUD/FOR MART dosing, especially in low adherence scenarios. In model simulations and the real-world setting, FF/VI generally provided longer bronchoprotection, lower systemic activity, and greater clinical benefits over BUD/FOR as well as consistently higher adherence. Conclusion In this literature review and modelling analysis, FF/VI was found to show clinical advantages on asthma control over BUD/FOR. These findings have implications for helping clinicians select the most suitable inhaled therapy for their patients with asthma. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02585-z.

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Section: Discussionmentioning

confidence: 99%

Assessing the Effects of Changing Patterns of Inhaled Corticosteroid Dosing and Adherence with Fluticasone Furoate and Budesonide on Asthma Management

Daley‐Yates¹,

Singh

Igea³

et al. 2023

Adv Ther

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“…This could be explained by the finding that more physicians prioritize symptom control than exacerbation risk in patients with mild asthma [287/736 (9.0%) vs. 85/736 (11.5%), respectively] [ 72 ], since the SYGMA 1 study showed inferior symptom control with as-needed ICS-FOR versus regularly dosed ICS [ 65 , 72 ], and a retrospective matched cohort study demonstrated better symptom control with once-daily fluticasone furoate-vilanterol versus twice-daily BUD-FOR [ 73 ]. Importantly, patients receiving ICS-FOR MART remain susceptible to SABA overuse; the APPaRENT studies reported that 85.4% (479/561) of physicians prescribed SABA in addition to MART (APPaRENT 1) [ 72 ], with the same incorrect use of MART reported by 85% (521/616) of patients (APPaRENT 2) [ 74 ].…”

Section: Differences Between Treatment Guidelines and Physician Attit...mentioning

confidence: 99%

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription

Domingo

Singh

2023

Adv Ther

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Short-acting b 2 agonists (SABAs) have been a mainstay of asthma treatment since the 1950s, and have been mainly recommended as-needed for symptom relief alongside daily inhaled corticosteroid (ICS)-based maintenance treatment for the past 30 years. However, patient adherence to regular ICS-based anti-inflammatory maintenance therapy is frequently poor, leading to SABA overuse for symptom relief and associated poor outcomes. At present, there is a lack of consensus between treatment guidelines on how SABA should be used, and as-needed ICS-formoterol is suggested by some as an alternative reliever therapy. Here, we examine the pharmacology and current use of inhaled SABAs, identify that regular dosing of ICS can encourage appropriate SABA use, and appraise the evidence used to support the changing reliever treatment recommendations. We conclude that SABA continues to play an important role in the asthma management landscape, and give our views on how it should be used in patients with mild-moderate asthma, to complement regular ICS-based maintenance treatment.

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“…Chapman and others [41,42] conducted two studies to investigate how current clinical practice in various countries around the globe relates to the latest GINA recommendations, APPaRENT1 [41] and APPaRENT2 [42]. In APPaRENT1, the study team recruited patients and GPs from Australia, Canada, China, and the Philippines.…”

Section: Adopting New Changes and Poor Patient Educationmentioning

confidence: 99%

Impact of the GINA asthma guidelines 2019 revolution on local asthma guidelines and challenges: special attention to the GCC countries

Allehebi,

AL-Jahdali

2023

Explor Asthma Allergy

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The Global Initiative for Asthma (GINA) provides the most comprehensive and frequently updated guidelines for the management of asthma. The primary aim of guidelines is to bridge the gap between research and current medical practice by presenting the best available evidence to aid clinical decision-making, thereby improving patient outcomes, quality of care, and cost-effectiveness. Guidelines are particularly useful in situations where scientific evidence is limited, multiple treatment options exist, or there is uncertainty about the best course of action. However, due to variations in healthcare system structures, many countries have developed their own local guidelines for the management of asthma. Adoption of GINA recommendations into local guidelines has been uneven across different countries, with some embracing the changes while others continue to follow older approaches. This review article will explore the impact of the noteworthy changes in GINA guidelines, particularly in the 2019 version, on local guidelines and some of the challenges associated with implementing them.

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Patients' and physicians’ perspectives on the burden and management of asthma: Results from the APPaRENT 2 study

Cited by 18 publications

References 26 publications

Assessing the Effects of Changing Patterns of Inhaled Corticosteroid Dosing and Adherence with Fluticasone Furoate and Budesonide on Asthma Management

Assessing the Effects of Changing Patterns of Inhaled Corticosteroid Dosing and Adherence with Fluticasone Furoate and Budesonide on Asthma Management

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription

Impact of the GINA asthma guidelines 2019 revolution on local asthma guidelines and challenges: special attention to the GCC countries

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