Background: Adherence to inhaled drugs is linked to patients' satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects.Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged >= 65 years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3-6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration.Results: A total of 411 asthmatics (F/M: 238/173, mean age +/- SD: 72 +/- 5 years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score <= 19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p < 0.001 for both comparisons) with a significant increase of the ACT score (from 19 +/- 4.9 to 20 +/- 4.0, p < 0.001).Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.

Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects

Caminati, M.;
2019-01-01

Abstract

Background: Adherence to inhaled drugs is linked to patients' satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects.Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged >= 65 years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3-6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration.Results: A total of 411 asthmatics (F/M: 238/173, mean age +/- SD: 72 +/- 5 years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score <= 19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p < 0.001 for both comparisons) with a significant increase of the ACT score (from 19 +/- 4.9 to 20 +/- 4.0, p < 0.001).Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.
ACT, asthma control test
AHDS, hospital anxiety depression scale
Asthma
CFC, chlorofluorocarbons
Device misuse
EDUCA, elderly and device use in chronic asthma
Education
Elderly
FEV1, forced expiratory volume 1s second
FVC, forced vital capacity
ICS, inhaled corticosteroids
LABA, long-acting β2 agonist
LAMA, long-acting muscarinic antagonists
MCS, mental health composite score
PCS, physical health composite score
PROs, patient-reported outcomes
SAE, severe asthma exacerbation
SF12, short form health survey
mMRC, modified medical research council
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1074654
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