Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study

Research article - Open Access - Open Peer Review

David B. Price, Vicky Thomas, P. N. Richard Dekhuijzen, Sinthia Bosnic-Anticevich, Nicolas Roche, Federico Lavorini, Priyanka Raju, Daryl Freeman, Carole Nicholls, Iain R. Small, Erika Sims, Guilherme Safioti, Janice Canvin and Henry Chrystyn

Open Peer Review reports

Abstract

Background

Incorrect inhaler technique is a common cause of poor asthma control. This two-phase pragmatic study evaluated inhaler technique mastery and maintenance of mastery with DuoResp® (budesonide-formoterol [BF]) Spiromax® compared with Symbicort® (BF) Turbuhaler® in patients with asthma who were receiving inhaled corticosteroids/long-acting β2-agonists.

Methods

In the initial cross-sectional phase, patients were randomized to a 6-step training protocol with empty Spiromax and Turbuhaler devices. Patients initially demonstrating ≥1 error with their current device, and then achieving mastery with both Spiromax and Turbuhaler (absence of healthcare professional [HCP]-observed errors), were eligible for the longitudinal phase. In the longitudinal phase, patients were randomized to BF Spiromax or BF Turbuhaler. Co-primary endpoints were the proportions of patients achieving device mastery after three training steps and maintaining device mastery (defined as the absence of HCP-observed errors after 12 weeks of use). Secondary endpoints included device preference, handling error frequency, asthma control, and safety. Exploratory endpoints included assessment of device mastery by an independent external expert reviewing video recordings of a subset of patients.

Results

Four hundred ninety-three patients participated in the cross-sectional phase, and 395 patients in the longitudinal phase. In the cross-sectional phase, more patients achieved device mastery after three training steps with Spiromax (94%) versus Turbuhaler (87%) (odds ratio [OR] 3.77 [95% confidence interval (CI) 2.05–6.95], p < 0.001). Longitudinal phase data indicated that the odds of maintaining inhaler mastery at 12 weeks were not statistically significantly different (OR 1.26 [95% CI 0.80–1.98], p = 0.316). Asthma control improved in both groups with no significant difference between groups (OR 0.11 [95% CI -0.09–0.30]). An exploratory analysis indicated that the odds of maintaining independent expert-verified device mastery were significantly higher for patients using Spiromax versus Turbuhaler (OR 2.11 [95% CI 1.25–3.54]).

Conclusions

In the cross-sectional phase, a significantly greater proportion of patients using Spiromax versus Turbuhaler achieved device mastery; in the longitudinal phase, the proportion of patients maintaining device mastery with Spiromax versus Turbuhaler was similar. An exploratory independent expert-verified analysis found Spiromax was associated with higher levels of device mastery after 12 weeks. Asthma control was improved by treatment with both BF Spiromax and BF Turbuhaler.

Download PDF

(You must be logged in to add and reply comments)

Interasma on Twitter

Interasma RT @Aller_MD: Egg Allergy? Don't Let That Stop You From Getting Vaccinated https://t.co/0ZBe68O1fa
7hreplyretweetfavorite
Interasma Top story: Marijuana Cannabis Allergy https://t.co/c4bzRhT0oj, see more https://t.co/CpGiFuOOYd
10hreplyretweetfavorite
Interasma RT @Aller_MD: Top story: Marijuana Cannabis Allergy https://t.co/dEin0Cq9kK, see more https://t.co/jgCeENQuZt
15hreplyretweetfavorite
Interasma RT @Aller_MD: Decline in measles vaccination is causing a preventable global resurgence of the disease https://t.co/fHQXw8Fwrk
15hreplyretweetfavorite
Interasma RT @Aller_MD: Discovery may help explain why women get autoimmune diseases far more often than men https://t.co/s1aSxX9mTW
15hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma