A major study, the first of its kind in the world, involving the records of nearly a million patients, has concluded that asthma sufferers had significantly better control of their condition using breath actuated inhalers than the more traditional 'press and breathe' devices.
There are currently more than 5 million people in the UK who are living with asthma and researchers at the University of Aberdeen are working on the theory that some people's condition may have substantially differing outcomes, depending on the type of inhaler they use.
In the treatment of asthma, there are a wide variety of inhaler devices available for the delivery of medication into the lungs. In spite of the proven effectiveness of inhaled medication in randomised controlled trials, there is evidence of less than adequate outcomes of asthma care in the community, with high levels of avoidable deaths and impairment of quality of life for asthma sufferers.
David Price, General Practice Airways Group Professor of Primary Care Respiratory Medicine, University of Aberdeen, who led the study, commented: "The study utilised a large and well-validated clinical database that accessed the routine general practice medical records of almost 900,000 patients being treated in the UK. The study found that outcomes were consistently better in those using the breath-actuated device, with less use of rescue medication for asthma symptoms, fewer courses of steroids (prescribed for asthma exacerbations) and less courses of antibiotics for respiratory infections prescribed to this group. This group also had less GP consultations for asthma and for respiratory infections."
Current guidelines suggest no difference in the clinical and cost-effectiveness use of different inhalers in the treatment of asthma and currently regard most inhalers as the same, except in unusual circumstances, for example, patients who are unable to use the cheapest press and breathe-metred dose inhalers effectively despite adequate instruction.
Worldwide studies to date relating to inhalers have been conducted under strict randomised controlled trials with restricted entry criteria and protocols that do not replicate normal care. This means that because the studies were carried out on very selected groups of patients treated and monitored in a very intensive way, extrapolating the results to all patients treated in usual clinical settings may not be justified. These studies have shown no differences between older 'press and breathe' inhalers and newer inhalers, which have been designed to be easier to use by patients.
Most patients in the UK, in contrast to elsewhere in Northern Europe, receive 'press and breathe' inhalers and the University team along with other UK colleagues, set out to examine whether this was appropriate. The observational 12-month study was led by two members from the University's Department of General Practice and Primary Care: Professor Price and Dr Mike Thomas. They compared levels of asthma control and the need and number of doctor appointments for patients using the different devices. The breath-actuated pressurised inhaler, Easi-breath device, like many newer inhaler devices, is designed to overcome some of the co-ordination difficulties patients may face using traditional 'press and breathe' inhalers.
The authors concluded that children and adults using the breath-actuated device had better asthma control than those using traditional 'press and breathe' inhalers. Their findings are significant and have never before emerged from previous controlled trials from around the world.