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 β2-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.

Efficacy of fluticasone propionate/formoterol fumarate in the treatment of asthma: A pooled analysis

“…In clinical practice, several factors can affect the ability of patients to achieve the clinical outcomes obtained in controlled conditions. The use of single-inhaler ICS/LABA combinations has been shown to increase patient adherence to treatment compared with the use of separate inhalers [3,4], which may help improve asthma outcomes.…”

“…Fluticasone is a potent ICS [5] and formoterol is the fastest-acting inhaled LABA currently available for the treatment of asthma in a combination inhaler [6,7]. A rapid onset of action may be an important attribute of an ICS/LABA maintenance therapy for patients [4,8]; recent studies have suggested that therapies with a rapid onset of bronchodilation may encourage patient adherence to their treatment regimen [9,10]. Furthermore, fluticasone/formoterol has been shown in vitro to have a high fine particle fraction (FPF), to exhibit negligible flow-rate dependency [11], and has also demonstrated a slow, warm and prolonged aerosol plume [ [12]; unpublished data] factors which may correlate with corresponding high levels of lung deposition in vivo.…”

A 12-week open-label, randomized, controlled trial and 24-week extension to assess the efficacy and safety of fluticasone propionate/formoterol in children with asthma

“…Furthermore, the use of single-inhaler ICS/LABA combinations has been shown to increase patients' treatment adherence compared with separate inhalers [Murphy and Bender, 2009], which may improve outcomes.…”

Onset of Bronchodilation with Fluticasone/Formoterol Combination Versus Fluticasone/Salmeterol in an Open-Label, Randomized Study

“…Achieving asthma control is also hindered by perceptual barriers, contributing to reduced patient adherence to treatment regimens [8,9]. Studies have suggested that therapies with a rapid onset of bronchodilation may encourage adherence and, thus, improve real-world asthma outcomes [10,11].…”