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Clinical outcomes in people with difficult-to-control asthma using electronic monitoring to support medication adherence.

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journal contribution
posted on 2020-12-03, 09:30 authored by Claire E Boddy, Shamsa Naveed, Michelle Craner, Anna Murphy, Salman Siddiqui, Peter Bradding
Background
Nonadherence in difficult-to-control asthma can be identified using 7-day FeNO suppression testing where patients take additional fluticasone via Diskus with an Inhaler Compliance Assessment (INCA) acoustic monitoring device attached, and self-measure FeNO at home. However, this is inconvenient for patients attending a tertiary center and limited by FeNO meter availability. It is not known if this approach alters clinical outcomes.

Objectives
To examine patient acceptability and the effectiveness of replacing usual combination inhaled corticosteroid (ICS)/long-acting β 2 -agonist (LABA) therapy with a fluticasone/salmeterol Diskus 500+INCA for 28 days as the initial intervention, compared with the 7-day FeNO suppression test, and to explore clinical outcomes after INCA monitoring.

Methods
A service evaluation of FeNO suppression testing was undertaken in clinical practice.

Results
Twenty-one of 23 subjects offered replacement of their usual ICS/LABA with fluticasone/salmeterol+INCA as the initial intervention accepted and completed 28 days of monitoring. Fourteen (66.6%) patients reduced their FeNO by >42% (FeNO suppressors), accompanied by improvements in forced expiratory volume in 1 second, Asthma Control Questionnaire, and blood eosinophils, similar to the 7-day test (n = 74). Twenty-two of 62 (35.5%) FeNO suppressors progressed to biological therapy, compared with 24 of 33 (72.7%) nonsuppressors ( P = .0006). FeNO suppressors taking maintenance prednisolone (n = 13) who did not receive biological therapy reduced the median baseline dose from 10 to 3 mg, with further reductions limited by adrenal suppression.

Conclusion
Replacing existing inhaled therapy with fluticasone/salmeterol+INCA for 28 days is acceptable to the majority of people with difficult-to-control asthma and identifies prior medication nonadherence. INCA monitoring coupled with clinical support potentially improves patient adherence and asthma control, preventing unnecessary progression to biological therapy.

History

Author affiliation

Department of Respiratory Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

The journal of allergy and clinical immunology. In practice

Publisher

Elsevier BV

issn

2213-2198

eissn

2213-2201

Acceptance date

2020-10-27

Copyright date

2020

Available date

2021-11-10

Spatial coverage

United States

Language

eng

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