Limited treatment adaptation despite poor asthma control in asthma patients treated with inhaled corticosteroids

Abstract

Objective: Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control. Methods: General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression. Results: Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion. Conclusions: Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient.

• Asthma
• asthma control
• treatment adaptation
• inhaled corticosteroids

Acknowledgements

The authors would like to express their thanks to Professor Françoise Neukirch, Epidemiology of Respiratory Diseases Unit, INSERM U700, Xavier Bichat School of Medicine, Paris, France and to the late Professor Philippe Godard, Respiratory Medicine Department, Hôpital Arnaud de Villeneuve, CHU Montpellier, France for their invaluable advice and insight into the design, implementation and interpretation of this study.

Declaration of interest

N.R., P.D. and E.V.G. were members of the study steering committee, for which they received honoraria from GlaxoSmithKline. N.R. has received grants, funding, honoraria, speaker fees or consultancy fees from Aerocrine, Almirall, Astra-Zeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda Pharma, MundiPharma, Novartis, Takeda-Nycomed, Pfizer, Roche and Teva. P.D. has received honoraria, speaker fees and consultancy fees from GlaxoSmithKline, Astra Zeneca and Chiesi, honoraria from Takeda-Nycomed and is an advisory board member for Chiesi and Takeda-Nycomed. E.V.G. has received consultancy fees from Astra-Zeneca and Boehringer Ingelheim, grants or funding from Boehringer Ingelheim and Pfizer and honoraria from Astra-Zeneca and Chiesi. I.B., G.N. and C.P. are employees of GlaxoSmithKline. S.S., J.M. and J.D. are employees of Kappa Santé, the contract research organisation mandated by GlaxoSmithKline for the implementation of the study. This study was funded by Laboratoire GlaxoSmithKline, manufacturer of fluticasone propionate and beclometasone, inhaled corticosteroids (ICS) used in the treatment of asthma, as well as several bronchodilators. The funding source, together with the steering committee, and in close coordination with the French health authorities designed the study. Operational management of the study and data analysis were subcontracted to Kappa Santé, an independent contract research organisation. The funding source, together with the steering committee and Kappa Santé, were responsible for the interpretation of the findings and preparation of the study report and the present article.