Patient preferences for symptom-driven or regular preventer treatment in mild to moderate asthma – findings from the PRACTICAL study, a randomised clinical trial

Christina Baggott; Helen K. Reddel; Jo Hardy; Jenny Sparks; Mark Holliday; Andrew Corin; Barney Montgomery; Jim Reid; Davitt Sheahan; Robert J. Hancox; Mark Weatherall; Richard Beasley; James Fingleton

doi:10.1183/13993003.02073-2019

Abstract

Symptom-driven low-dose inhaled corticosteroid-formoterol is safe and effective in mild asthma and has been recommended as one of the preferred treatment regimens at steps 1 and 2 in the 2019 update of the Global Initiative for Asthma (GINA). However there are no data on patient preferences for this regimen.

A subgroup of participants in the PRACTICAL study (ACTRN12616000377437), a randomised control trial comparing symptom-driven budesonide-formoterol with maintenance budesonide plus as-needed terbutaline, completed a survey on treatment preferences, satisfaction, beliefs and experience at their final study visit.

306 of 407 eligible participants (75%) completed the survey. Regimen preference was strongly associated with randomised treatment as were preferences for and beliefs about preventer inhaler use. Combination preventer and reliever as needed therapy was preferred by 135/150 (90%, 95% CI 85.2 to 94.8) who were randomised to as-needed budesonide-formoterol, and by 63/156 (40%, 95% CI 32.7 to 48.1) who were randomised to maintenance budesonide. By contrast, twice daily preventer inhaler with a reliever inhaler as required was preferred by 15/150 (10%) of those randomised to as-needed budesonide-formoterol and 93/156 (60%) of those randomised to maintenance budesonide. Satisfaction with all study inhalers was high. Of patients randomised to as-needed budesonide-formoterol (n=138), 92% were confident using it as a reliever at the end of the study.

Although most participants preferred the regimen to which they had been randomised, this association was much stronger for those randomised to budesonide-formoterol as needed, indicating that most patients preferred as-needed corticosteroid-formoterol therapy if they had experienced it.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Baggott reports grants from Health Research Council of New Zealand, during the conduct of the study; personal fees from Astra Zeneca, personal fees from Novartis, outside the submitted work.

Conflict of interest: Dr. Reddel reports grants from Health Research Council of New Zealand, during the conduct of the study; grants and personal fees from AstraZeneca, grants, personal fees and non-financial support from GlaxoSmithKline, personal fees from Merck, grants and personal fees from Novartis, personal fees from Teva, personal fees from Mundipharma, personal fees from Boehringer Ingelheim, outside the submitted work; and Dr Reddel is Chair of the GINA Scientific Committee.

Conflict of interest: Dr. Hardy reports grants from Health Research Council of New Zealand, during the conduct of the study; personal fees from Astra Zeneca, outside the submitted work.

Conflict of interest: Ms Sparks reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Mr. Holliday reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Dr. Corin reports grants from Health Research Council of New Zealand, during the conduct of the study; grants and personal fees from Astra Zeneca, personal fees from GaxoSmithCline, grants from resTORbio, grants from Regeneron, grants from Esperion, grants from Connect Biopharma, grants from Luitpold, other from PHARMAC, outside the submitted work.

Conflict of interest: Dr. Montgomery reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Dr. Reid reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Dr. Sheahan reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Dr. Hancox reports grants from Health Research Council of New Zealand, during the conduct of the study; grants from Astra Zeneca, other from Boehringer Ingelheim, personal fees from Menarini, outside the submitted work.

Conflict of interest: Dr. Weatherall reports grants from Health Research Council of New Zealand, during the conduct of the study.

Conflict of interest: Dr. Beasley reports grants from Health Research Council of New Zealand, during the conduct of the study; grants and personal fees from Astra Zeneca, grants from GlaxoSmithKline, grants from Genentech, personal fees from Theravance, outside the submitted work.

Conflict of interest: Dr. Fingleton reports grants from Health Research Council of New Zealand, during the conduct of the study; grants, personal fees and non-financial support from AstraZeneca, grants from GlaxoSmithKline, grants from Genentech, personal fees and non-financial support from Boerhinger Ingleheim, outside the submitted work.

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