Inhaler reminders improve adherence with controller treatment in primary care patients with asthma

J Allergy Clin Immunol. 2014 Dec;134(6):1260-1268.e3. doi: 10.1016/j.jaci.2014.05.041. Epub 2014 Jul 22.

Abstract

Background: Poor adherence contributes to uncontrolled asthma. Pragmatic adherence interventions for primary care settings are lacking.

Objective: To test the effectiveness of 2 brief general practitioner (GP)-delivered interventions for improving adherence and asthma control.

Methods: In a 6-month cluster randomized 2 × 2 factorial controlled trial, with GP as unit of cluster, we compared inhaler reminders and feedback (IRF) and/or personalized adherence discussions (PADs) with active usual care alone; all GPs received action plan and inhaler technique training. GPs enrolled patients prescribed combination controller inhalers, with suboptimal Asthma Control Test (ACT) scores (ACT score ≤19). Inhaler monitors recorded fluticasone propionate/salmeterol adherence (covertly for non-IRF groups) and, in IRF groups, provided twice-daily reminders for missed doses, and adherence feedback. PAD GPs received communication training regarding adherence. Outcomes collected every 2 months included ACT scores (primary outcome) and severe exacerbations. Intention-to-treat mixed-model analysis incorporated cluster effect and repeated measures.

Results: A total of 43 GPs enrolled 143 patients with moderate-severe asthma (mean age, 40.3 ± 15.2 years; ACT score, 14.6 ± 3.8; fluticasone propionate dose, 718 ± 470 μg). Over 6 months, adherence was significantly higher in the IRF group than in non-IRF groups (73% ± 26% vs 46% ± 28% of prescribed daily doses; P < .0001), but not between PAD and non-PAD groups. Asthma control improved overall (mean change in ACT score, 4.5 ± 4.9; P < .0001), with no significant difference among groups (P = .14). Severe exacerbations were experienced by 11% of the patients in IRF groups and 28% of the patients in non-IRF groups (P = .013; after adjustment for exacerbation history; P = .06).

Conclusions: Inhaler reminders offer an effective strategy for improving adherence in primary care compared with a behavioral intervention or usual care, although this may not be reflected in differences in day-to-day asthma control.

Keywords: Medication adherence; ambulatory monitoring; antiasthmatic agents; asthma; health communication; intervention studies; treatment effectiveness.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / therapeutic use
  • Adult
  • Aged
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Androstadienes / therapeutic use*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Drug Combinations
  • Female
  • Fluticasone-Salmeterol Drug Combination
  • General Practitioners
  • Glucocorticoids / therapeutic use
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Nebulizers and Vaporizers / statistics & numerical data*
  • Primary Health Care
  • Professional-Patient Relations
  • Young Adult

Substances

  • Adrenergic beta-2 Receptor Agonists
  • Androstadienes
  • Anti-Asthmatic Agents
  • Drug Combinations
  • Fluticasone-Salmeterol Drug Combination
  • Glucocorticoids
  • Albuterol