11.12.2013
Inhaler Dose Counters Reduce Visits to ED.
Dose counters on rescue inhalers reduced emergency department visits, a real-world observational study showed.
Adjusted incidence of emergency encounters for respiratory reasons was 45% lower among patients with an albuterol inhaler that had an integrated dose counter compared with those with no dose counter on their inhaler (rate 0.4% versus 0.9%, P<0.001), reported Anna Rigazio, MSc, a statistician at Research in Real Life, a clinical database and research organization based in Cambridge, England.
Severe exacerbations were equally common in the two groups, though, suggesting that fewer trips to the hospital stemmed from cutting down on preventable emergencies, said Rigazio, who presented the results here at the American College of Allergy, Asthma, and Immunology meeting.
"If you use your inhaler and it's empty, of course it doesn't help you to treat the exacerbation, and therefore patients run to emergency department visits," she summed up in an interview with MedPage Today.
The results confirm an expected benefit of the dose counters that most rescue bronchodilators now come with, commented Jay Portnoy, MD, director of allergy, asthma, and immunology at Children's Mercy Hospital in Kansas City, Mo.
"The problem with inhalers is that when you have used the last dose, it will continue to puff but won't be as effective ... [because] as the liquid falls lower a smaller dose gets delivered," he explained.
Physicians could write their prescriptions to specify that the inhaler be one with a dose counter, but patients would be wise to insist on it at the pharmacy, he suggested.
"All of the companies are putting dose counters on new inhalers, but they are still trying to get rid of old stock without the dose counters, so patients occasionally get one without," he told MedPage Today.
Sanjay Sethi, MD, chief of pulmonary, critical care, and sleep medicine at the University at Buffalo, State University of New York, agreed but didn't see it as a uniform requirement.
"Given a choice, if all things are equal, a dose counter is a good idea and can improve adherence and prevent gaps in therapy," he said.
But, he added, "In my well-controlled, compliant patients who are using inhalers without dose counters, I would not change their treatment just to include a dose counter."
He criticized the lack of adjustment for inhaled corticosteroid use, which was different between groups, and noted the limitations of retrospective administrative data analysis.
The study included 93,980 patients ages 4 to 64 starting on and staying on an albuterol metered-dose inhaler as their only short-acting beta agonist from Jan. 1, 2010, through Sept. 30, 2011, in a U.S. insurance claims database.
Most patients (72%) were on an inhaler with a dose counter, which at the time was just the Ventolin brand. The other 28% were on the ProAir or Proventil inhalers without a dose counter.
Data from the year prior to rescue inhaler initiation was analyzed for confounding factors that differed between those patient groups.
The biggest reduction - 83% lower relative odds - in respiratory-related emergency department visits associated with a dose counter accrued to patients whose primary diagnosis was exercise-induced bronchospasm (P=0.020).
For patients with a primary diagnosis of chronic obstructive pulmonary disease (COPD), the rate ratio was reduced by 60% with that feature on their rescue inhaler (P=0.005).
For those with asthma, dose-counter inhalers were associated with a rate ratio of 0.49 (P<0.001).
Severe exacerbations - defined by respiratory-related emergency visits, hospitalization, or use of acute oral corticosteroids or primary care consultation for a lower respiratory event treated with antibiotics in COPD - were statistically and numerically similar in all three groups between dose-counter and no-dose-counter inhalers.
But acute oral corticosteroid use was slightly higher in the dose-counter group (P=0.042). "Dose counters may improve appropriate use of healthcare," Rigazio noted.
Source: http://www.medpagetoday.com/
Dose counters on rescue inhalers reduced emergency department visits, a real-world observational study showed.
Adjusted incidence of emergency encounters for respiratory reasons was 45% lower among patients with an albuterol inhaler that had an integrated dose counter compared with those with no dose counter on their inhaler (rate 0.4% versus 0.9%, P<0.001), reported Anna Rigazio, MSc, a statistician at Research in Real Life, a clinical database and research organization based in Cambridge, England.
Severe exacerbations were equally common in the two groups, though, suggesting that fewer trips to the hospital stemmed from cutting down on preventable emergencies, said Rigazio, who presented the results here at the American College of Allergy, Asthma, and Immunology meeting.
"If you use your inhaler and it's empty, of course it doesn't help you to treat the exacerbation, and therefore patients run to emergency department visits," she summed up in an interview with MedPage Today.
The results confirm an expected benefit of the dose counters that most rescue bronchodilators now come with, commented Jay Portnoy, MD, director of allergy, asthma, and immunology at Children's Mercy Hospital in Kansas City, Mo.
"The problem with inhalers is that when you have used the last dose, it will continue to puff but won't be as effective ... [because] as the liquid falls lower a smaller dose gets delivered," he explained.
Physicians could write their prescriptions to specify that the inhaler be one with a dose counter, but patients would be wise to insist on it at the pharmacy, he suggested.
"All of the companies are putting dose counters on new inhalers, but they are still trying to get rid of old stock without the dose counters, so patients occasionally get one without," he told MedPage Today.
Sanjay Sethi, MD, chief of pulmonary, critical care, and sleep medicine at the University at Buffalo, State University of New York, agreed but didn't see it as a uniform requirement.
"Given a choice, if all things are equal, a dose counter is a good idea and can improve adherence and prevent gaps in therapy," he said.
But, he added, "In my well-controlled, compliant patients who are using inhalers without dose counters, I would not change their treatment just to include a dose counter."
He criticized the lack of adjustment for inhaled corticosteroid use, which was different between groups, and noted the limitations of retrospective administrative data analysis.
The study included 93,980 patients ages 4 to 64 starting on and staying on an albuterol metered-dose inhaler as their only short-acting beta agonist from Jan. 1, 2010, through Sept. 30, 2011, in a U.S. insurance claims database.
Most patients (72%) were on an inhaler with a dose counter, which at the time was just the Ventolin brand. The other 28% were on the ProAir or Proventil inhalers without a dose counter.
Data from the year prior to rescue inhaler initiation was analyzed for confounding factors that differed between those patient groups.
The biggest reduction - 83% lower relative odds - in respiratory-related emergency department visits associated with a dose counter accrued to patients whose primary diagnosis was exercise-induced bronchospasm (P=0.020).
For patients with a primary diagnosis of chronic obstructive pulmonary disease (COPD), the rate ratio was reduced by 60% with that feature on their rescue inhaler (P=0.005).
For those with asthma, dose-counter inhalers were associated with a rate ratio of 0.49 (P<0.001).
Severe exacerbations - defined by respiratory-related emergency visits, hospitalization, or use of acute oral corticosteroids or primary care consultation for a lower respiratory event treated with antibiotics in COPD - were statistically and numerically similar in all three groups between dose-counter and no-dose-counter inhalers.
But acute oral corticosteroid use was slightly higher in the dose-counter group (P=0.042). "Dose counters may improve appropriate use of healthcare," Rigazio noted.
Source: http://www.medpagetoday.com/