TY - JOUR
T1 - A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma
AU - Sulaiman, Imran
AU - Greene, Garrett
AU - MacHale, Elaine
AU - Seheult, Jansen
AU - Mokoka, Matshediso
AU - D’Arcy, Shona
AU - Taylor, Terence
AU - Murphy, Desmond M.
AU - Hunt, Eoin
AU - Lane, Stephen J.
AU - Diette, Gregory B.
AU - Mark FitzGerald, J.
AU - Boland, Fiona
AU - Bhreathnach, Aoife Sartini
AU - Cushen, Breda
AU - Reilly, Richard B.
AU - Doyle, Frank
AU - Costello, Richard W.
N1 - Funding Information:
Support statement: This was a researcher-initiated study, funded by the Health Research Board of Ireland (HRA POR/ 2011/59). The authors acknowledge support from the Dublin Clinical Centre for Research. GSK provided the Diskus inhaler for this study (GSK Study Code 114882). The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Funding information for this article has been deposited with the Crossref Funder Registry.
Publisher Copyright:
Copyright ©ERS 2018
PY - 2018/1/1
Y1 - 2018/1/1
N2 - In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio) feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence. Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis. The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%-17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%). Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.
AB - In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio) feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence. Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis. The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%-17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%). Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.
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U2 - 10.1183/13993003.01126-2017
DO - 10.1183/13993003.01126-2017
M3 - Article
C2 - 29301919
AN - SCOPUS:85040163122
SN - 0903-1936
VL - 51
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 1
M1 - 1701126
ER -