Treatment of moderate to severe asthma: patient perspectives on combination inhaler therapy and implications for adherence

Review

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Authors: Kevin R Murphy, Bruce G Bender

Published Date July 2009 Volume 2009:2 Pages 63 - 72

DOI: http://dx.doi.org/10.2147/JAA.S4214

Kevin R Murphy,¹ Bruce G Bender²

¹Allergy, Asthma and Pulmonary Research, Boys Town National Research Hospital, Omaha, Nebraska, USA; ²Division of Pediatric Behavioral Health, National Jewish Health, Denver, Colorado, USA

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.

Keywords: budesonide/formoterol, fluticasone/salmeterol, adherence, onset of effect, patient satisfaction

General overview: Control of asthma symptoms is achievable for most patients and is essential to reduce disease-associated morbidity. However, a recent survey showed that over half of adult patients have inadequately controlled asthma. A major factor contributing to the high level of uncontrolled asthma is lack of adherence to therapy. An examination of patients’ perspectives and preferences indicates that adherence is higher in patients who believe that their controller therapy is effective, with immediate and noticeable effects. The current treatments of moderate to severe asthma, inhaled corticosteroid/long-acting β2-agonist (combination therapy), fluticasone/salmeterol and budesonide/formoterol, have similar efficacy and tolerability. Research suggests, however, that patients prefer a therapy with fast onset and long duration of action; asthma therapies with a rapid onset of effect are highly valued and could lead to improved adherence. Thus, future research should focus on combination therapies with rapid onset and whether patient preference for these asthma medications increases adherence and outcome.