Asthma control with a breath-actuated pressurised metered dose inhaler (BAI) and prevalence of oral candidiasis: a prescribing claims study of 1701 patients prescribed a traditional pressurised metered dose inhaler (MDI) plus spacer or a BAI

Source: Annual Congress 2002 - Asthma in primary care - Assessment and control

Session: Asthma in primary care - Assessment and control
Session type: Thematic Poster Session
Number: 586

Disease area: Airway diseases

Abstract

A recent systematic review concluded that there is no evidence for greater effectiveness of alternative inhaler devices over the MDI, with or without a spacer(Brocklebank, D. BMJ 2001). In order to further investigate the real-life effectiveness of the MDI plus spacer (MDI + S) combination, a previous study showing that patients using an MDI for inhaled corticosteroid (ICS) were less well controlled than patients using a breath-actuated ICS (Easi-Breathe®) has been re-analysed examining the subgroup of MDI patients from the original cohort who were also prescribed a spacer. Patient records from the primary care database were analysed with regard to quantity of relief medication, oral steroid and antibiotic prescriptions and presence of oral candidiasis diagnoses. Patients were further categorised by age and according to whether the reference inhaler was a new ICS (New) or a change from an existing MDI (Existing). Demography was similar between groups.

			Average no. Prescriptions/patient/year			% of patients
	Status	n	Oral steroids	Oral antibiotics	Inhaled β2 agonist	Oral candidiasis
MDI + S	New	676	0.26	0.30	2.60	1.3
BAI	New	299	0.11	0.23	2.61	1.0
Variance			-58%p<0.05	-23%p=0.140	+0.4%p=0.843	-23%p=0.668
MDI + S	Existing	355	0.65	0.71	4.40	5.92
BAI	Existing	371	0.26	0.28	3.44	2.43
Variance			-60%p<0.05	-61%p<0.05	-22%p=0.04	-59%p=0.018

Overall less medication was prescribed to BAI patients compared to MDI + S patients, the greatest difference being in existing patients. These results suggest that patients' asthma may be better controlled and that less oral mucosal drug deposition occurs with a breath-actuated device.

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Citations should be made in the following way:
M. Thomas, D. Price, G. Mitchell, C. Niziol, R. Featherstone (London, Norwich, United Kingdom). Asthma control with a breath-actuated pressurised metered dose inhaler (BAI) and prevalence of oral candidiasis: a prescribing claims study of 1701 patients prescribed a traditional pressurised metered dose inhaler (MDI) plus spacer or a BAI. Eur Respir J 2002; 20: Suppl. 38, 586

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