Allergy and Airway: Asthma |

Treatment Satisfaction With Metered Dose and Dry Powder Inhalers in Patients With Bronchial Asthma FREE TO VIEW

Ashutosh Aggarwal, DM; Raman Kumari, MD; Sandeep Grover, MD
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Postgraduate Institute of Medical Education and Research, Chandigarh, India

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):13A. doi:10.1016/j.chest.2016.08.016
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To compare treatment satisfaction with inhaled therapy among asthmatics using metered dose inhaler (MDI) or dry powder inhaler (DPI), and to correlate it with treatment adherence, lung function, and airway inflammation.

METHODS: 200 adult patients of asthma (69 men and 131 women) using MDI or DPI regularly for at least one year were enrolled after obtaining informed consent. Pregnant women and patients with coexisting medical conditions that could potentially impair level of activity or worsen quality of life were excluded. Spirometry was performed, and Fractional Expired nitric oxide (FeNO) concentration was measured orally, for all patients. Asthma control was assessed as per Global Initiative Against Asthma (GINA) guidelines. Medication Adherence Questionnaire (MAQ) was used to evaluate adherence to treatment on a scale of 0-4, with higher scores indicating better adherence. Treatment satisfaction with inhaled therapy was assessed through the Hindi version of 14-item Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) in four domains - Effectiveness, Side effects, Convenience and Global Satisfaction, on a scale of 0-100, with higher scores implying greater satisfaction. Group differences for TSQM domain scores between MDI and DPI users were evaluated through an analysis of covariance (ANCOVA) model with MAQ score as covariate.

RESULTS: Study participants were using inhalers for a median of three years (interquartile range [IQR] 1-8 years). MDI and DPI (with both forms of devices manufactured in India) were being used by 115 and 85 asthmatics respectively. 62, 74 and 64 patients respectively had good, partial and poor control of asthma. More DPI users (36, 42.4%) had poor asthma control as compared to MDI users (28, 24.3%). MDI users reported better treatment adherence than DPI users (median [IQR] MAQ score 2 [1-3] vs 1 [1-3], p 0.043). As compared to DPI users, MDI users had significantly better median [IQR] TSQM domain scores for Effectiveness (72.2 [66.7-83.3] vs 66.7 [61.1-77.8], p 0.004), Convenience (72.2 [66.7-83.3] vs 66.7 [55.6-77.8], p 0.004), and Global Satisfaction (71.4 [64.3-78.6] vs 71.4 [57.1-78.6], p 0.035), but not Side Effects (100 [100-100] for both groups). These group differences remained significant after adjusting for MAQ scores in an ANCOVA model (p 0.020, 0.17, and 0.043 respectively for Effectiveness, Convenience and Global Satisfaction domains). TSQM Convenience and Global Satisfaction domain scores were significantly correlated with MAQ scores (Spearman’s coefficients 0.211 and 0.218 respectively, p 0.003 and 0.002 respectively). There was no significant correlation between any TSQM domain score and pulmonary function or measured FENO concentration.

CONCLUSIONS: Asthmatic patients derive greater treatment satisfaction with use of MDI rather than DPI. MDIs are also associated with better disease control and treatment adherence.

CLINICAL IMPLICATIONS: Wherever feasible, MDIs should be preferred over DPIs in optimizing treatment of bronchial asthma in India.

DISCLOSURE: The following authors have nothing to disclose: Ashutosh Aggarwal, Raman Kumari, Sandeep Grover

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