Efficacy and Safety of a Pressurized Metered-Dose Inhaler in Older Asthmatics: Comparison to a Dry Powder Inhaler in a 12-Week Randomized Trial
10.4168/aair.2020.12.3.454
- Author:
Seong Dae WOO
1
;
Young Min YE
;
Youngsoo LEE
;
So Hee LEE
;
Yoo Seob SHIN
;
Joo Hun PARK
;
Hyunna CHOI
;
Hyun Young LEE
;
Hyun Jung SHIN
;
Hae Sim PARK
Author Information
1. Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea. hspark@ajou.ac.kr
- Publication Type:Original Article
- Keywords:
Asthma;
aged;
metered dose inhalers;
dry powder inhalers;
airway management;
medication adherence
- MeSH:
Airway Management;
Asthma;
Dry Powder Inhalers;
Fluticasone;
Humans;
Inhalation;
Lung;
Medication Adherence;
Metered Dose Inhalers;
Nebulizers and Vaporizers;
Random Allocation
- From:Allergy, Asthma & Immunology Research
2020;12(3):454-466
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Asthma control in older asthmatics is often less effective, which may be attributed to small airway dysfunction and poor inhalation technique. We compared the efficacy of 2 inhalers (fluticasone propionate/formoterol treatment using a pressurized metered-dose inhaler [p-MDI group] vs. fluticasone propionate/salmeterol treatment using a dry powder inhaler [DPI group]) in older asthmatics.METHODS: We conducted a 12-week, randomized, open-label, parallel-designed trial in older patients (over 55 years old) with moderate-to-severe asthma, and compared the efficacy and safety for asthma control between the 2 groups. Subgroup analyses on disease duration and air trapping were performed. Clinical parameters, including changes in lung function parameters, inhaler technique and adherence, were compared with monitoring adverse reactions between the 2 groups.RESULTS: A total of 68 patients underwent randomization, and 63 (30 in the p-MDI group and 33 in the DPI group) completed this study. The p-MDI group was non-inferior to the DPI group with regard to the rate of well-controlled asthma (53.3% vs. 45.5%, P < 0.001; a predefined non-inferiority limit of 17%). In subgroup analyses, the proportion of patients who did not reach well-controlled asthma in the p-MDI group was non-inferior to that in the DPI group; the difference was 12.7% among those with a longer disease duration (≥ 15 years) and 17.5% among those with higher air-trapping (RV/TLC ≥ 45%), respectively (a predefined non-inferiority limit of 17%, P < 0.001). No significant differences were observed in lung function parameters, inhalation techniques, adherence and adverse reactions between the 2 groups.CONCLUSION: These results suggest that the p-MDI group may be comparable to the DPI group in the management of older asthmatics in aspects of efficacy and safety.
