Mitesh Patel1, Janine Pilcher2, Claire Munro3, Alexander Hosking3, Alison Pritchard3, Dominick Shaw4, Peter Black5, Mark Weatherall6, Richard Beasley7. 1. Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom. 2. Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand. 3. Medical Research Institute of New Zealand, Wellington, New Zealand. 4. Division of Respiratory Medicine, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom. 5. University of Auckland, Auckland, New Zealand; Deceased. 6. Capital and Coast District Health Board, Wellington, New Zealand; University of Otago, Wellington, New Zealand. 7. Medical Research Institute of New Zealand, Wellington, New Zealand; Capital and Coast District Health Board, Wellington, New Zealand; University of Otago, Wellington, New Zealand. Electronic address: richard.beasley@mrinz.ac.nz.
Abstract
BACKGROUND: The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring. OBJECTIVE: To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment. METHODS: Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit. RESULTS: The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5. CONCLUSION: Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.
RCT Entities:
BACKGROUND: The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring. OBJECTIVE: To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment. METHODS: Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit. RESULTS: The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5. CONCLUSION: Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.
Authors: Janine Pilcher; Philippa Shirtcliffe; Mitesh Patel; Steve McKinstry; Terrianne Cripps; Mark Weatherall; Richard Beasley Journal: BMJ Open Respir Res Date: 2015-11-06
Authors: Jieqiong Freda Yang; Rekha Chaudhuri; Neil C Thomson; Nitish Ramparsad; Hugh O'Pray; Stephen Barclay; Sean MacBride-Stewart; Craig McCallum; Varun Sharma; Charles McSharry; Dianne Murray; Malcolm Shepherd; Wai-Ting Nicola Lee Journal: NPJ Prim Care Respir Med Date: 2018-09-19 Impact factor: 2.871
Authors: Heinrich Worth; Carl-Peter Criée; Claus F Vogelmeier; Peter Kardos; Eva-Maria Becker; Karel Kostev; Ingo Mokros; Andrea Schneider Journal: Respir Res Date: 2021-04-16
Authors: Janine Pilcher; Mark Holliday; Stefan Ebmeier; Steve McKinstry; Fatiha Messaoudi; Mark Weatherall; Richard Beasley Journal: BMJ Open Respir Res Date: 2016-03-14