Scientific Respiratory Symposium, Paris June 2010

Figures & data

Figure 1 TORCH:⁴⁷ cost effectiveness per QUALY gained.

Note: Reproduced with permission from the European Respiratory Society ©.
Abbreviations: PL, placebo; SAL, salmeterol; FP, fluticasone proprionate; SFC, salmeterol plus fluticasone proprionate.

Table 1 TORCH:⁴⁷ pooled costs per region and QUALYs per region

	Pooled results, EQ-5D countries					Cost by region, EQ-5D countries*
	Cost ($US)*		QALYs
	Mean	SE	Mean	SE		PL	SAL	FP	SFC
PL	9,467	584	1.941	0.020	US	18,241	21,787	21,188	25,196
SAL	10,995	552	1.949	0.019	E Eur	4,403	6,141	6,883	7,196
FP	11,520	619	1.965	0.019	W Eur	5,856	6,209	6,886	7,290
SFC	12,950	586	2.022	0.018	Other	3,993	5,423	5,423	7,006

Notes:

* Local Currencies translated into $US by use of purchasing power parity statistics; adapted from Briggs et al.⁴⁷

Abbreviations: PL, placebo; SAL, salmeterol; FP, fluticasone proprionate; SFC, salmeterol plus fluticasone proprionate.

Table 2 Typical grading of clinical evidence

Grade of recommendation	Level of evidence
A	1a	Systematic review of RCTs
	1b	Individual RCT (with narrow confidence interval)
	1c	All or none – patients die without or live with
	2a	Systematic review of cohort studies
	2b	Individual cohort study (including low-quality RCT; eg, <80% follow-up)
	2c	Outcomes research
C	3a	Systematic review of case-control studies
	3b	Individual case-control study
	4	Case-series (and poor quality cohort and case-control studies)
D	5	Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles

Table 3 Possible reasons for such suboptimal levels of control

Insufficiently rigorous assessment of control

Inadequate maintenance therapy

Rhinitis, GER

Environmental exposures

Smoking

Being overweight

Device and Inhalation technique problems

Poor compliance

Abbreviation: GER, gastroesophageal reflux.

Figure 2 Percentage of patients making at least one error using their inhaler.⁷⁰

Note: *P < 0.05 compared with the best result (95% CI).
Abbreviations: CI, confidence intervals; pMDI, metered dose inhaler.

Figure 3 Percentage of patients making at least one critical error.⁷⁰

Note: *P < 0.05 compared with the best result (95% CI).
Abbreviations: CI, confidence intervals; pMDI, metered dose inhaler.

Table 4 Errors and omissions among unselected asthmatics on pMDI-delivered ICS⁷⁰

Cause of misuse	n	%
Omissions
No removal of cap	16	0
Inhaler not held correctly	260	7
Device not actuated at the beginning of the inspiration	748	19
No slow inspiratory flow	1348	34
No complete inspiration	919	23
>1 puff	739	19
No 5-s breath holding period at the end of inspiration	1753	44
Errors
Forced expiration	1077	27
No expiration	440	11
Inspiration by nose	480	12
Actuation at the end of inspiration	708	18
No inspiration	224	6

Abbreviations: ICS, inhaled corticosteroids; pMDI, metered dose inhaler.

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