Assessment of Adherence to Controller Inhalation Medication in Asthma- and COPD Patients.
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 141
- Locations
- 2
- Primary Endpoint
- Adherence to inhalation medication evaluated using the Test for the Adherence to Inhalers
Study Overview
Brief Summary
The main aim of the study is to evaluate the adherence to controller inhalation medication in asthma and Chronic Obstructive Pulmonary Disease (COPD) in Universitair Ziekenhuis Brussel. Adherence will be assessed using the 12-question Test for the Adherence to Inhalers (TAI) yielding a score indicating level of adherence (high, intermediate or poor). The TAI also provides some indication about the possible mechanisms of non-adherence (sporadic, deliberate or unconscious). The aim of the study is also to compare the adherence between the 2 study subgroups (asthma and COPD patients). Several other factors which could influence the compliance of the patients will also be evaluated: age, sex, pack years, FEV1 (Forced Expiratory Volume 1), exacerbation history, symptom control, type of inhaler and number of inhalers. By identifying different patient and treatment characteristics that lead to non-adherence, future education efforts could be better targeted to these patients presenting the most important unmet need in terms of adherence.
Detailed Description
Adherence to the controller inhalation medication is an important component of asthma and COPD care. Good adherence to the prescribed medication is asthma patients is associated with better symptom control and improved lung function. Also, lower exacerbation rate and mortality risk, less healthcare utilisation, lower healthcare-associated costs and a better quality of life are linked with better adherence in asthma and COPD patients.
However, studies have shown that the adherence to therapy in chronically ill patients averages around 50%. In asthma patients the level of adherence varies between 30-70%, while compliance rate in COPD patients is around 20-60% (though the numbers vary). Adherence in asthma and COPD patients is thus generally low.
Adherence in these patients is measured in studies in different ways: electronic device monitoring, dispensing data, drug levels or several self-administered questionnaires, among others. Each technique has its own benefits and drawbacks. However, the easiest to use are the self-administered questionnaires. Although many of these exist, a particularly interesting questionnaire is the TAI (Test for the Adherence to Inhalers). It exists in 2 versions: a 10-question and a longer 12-question test. The 12 question TAI has 2 added questions, in which a healthcare professional evaluates the use of the inhaler by the patient. All 12 questions can then be used to identify different non-compliance behavioural patterns. The advantages of this questionnaire are therefore that it can be used for both asthma and COPD patients, that it is designed specifically for inhalation medication and that it not only measures adherence but also the type of non-compliance .
The main aim of the study is thus to evaluate the adherence to controller inhalation medication in asthma and COPD in Universitair Ziekenhuis Brussel. Adherence will be assessed using the 12-question TAI (Test for the Adherence to Inhalers). The aim of the study is also to compare the adherence between the 2 study subgroups (asthma and COPD patients). Several other factors which could influence the compliance of the patients will also be evaluated: age, sex, pack years, FEV1, exacerbation history, symptom control, type of inhaler and number of inhalers. By identifying different patient and treatment characteristics that lead to non-adherence, future education efforts could be better targeted to these patients presenting the most important unmet need in terms of adherence.
Patient recruitment will take place at the Universitair Ziekenhuis Brussel respiratory outpatient clinic. Before their scheduled appointment, patients they will be screened to participate in the study. Recruitment will start January 2019 until March 2019, or until the target number of patients is reached. On the day of their appointment, the participants will receive all necessary information about the study and the informed consent process from the principal investigator.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Other
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Asthmatics with treatment ≥ GINA step
- •COPD-patients , GOLD stage II-IV.
Exclusion Criteria
- •No spirometry results available.
- •COPD patients not on long-acting bronchodilators.
Arms & Interventions
Asthmatics
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- FEV1 derived from the last spirometry (including spirometry performed on day of study visit).
- GINA step (Global Initiative for Asthma).
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of asthma.
- FENO (Fraction Exhaled Nitric Oxide) from the day of the study visit (if available).
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The Asthma Control Test (ACT)
Intervention: The 12-question TAI (Other)
Asthmatics
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- FEV1 derived from the last spirometry (including spirometry performed on day of study visit).
- GINA step (Global Initiative for Asthma).
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of asthma.
- FENO (Fraction Exhaled Nitric Oxide) from the day of the study visit (if available).
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The Asthma Control Test (ACT)
Intervention: Information from patients file (Other)
Asthmatics
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- FEV1 derived from the last spirometry (including spirometry performed on day of study visit).
- GINA step (Global Initiative for Asthma).
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of asthma.
- FENO (Fraction Exhaled Nitric Oxide) from the day of the study visit (if available).
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The Asthma Control Test (ACT)
Intervention: The Asthma Control Test (ACT) (Other)
COPD-patients
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- Pack Years
- GOLD stage (Global Initiative for Chronic Obstructive Lung Disease)(post-bronchodilator FEV1)
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of COPD.
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The COPD Assessment Test (CAT)
Intervention: The 12-question TAI (Other)
COPD-patients
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- Pack Years
- GOLD stage (Global Initiative for Chronic Obstructive Lung Disease)(post-bronchodilator FEV1)
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of COPD.
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The COPD Assessment Test (CAT)
Intervention: Information from patients file (Other)
COPD-patients
From the patients file the following information will be collected by the investigators:
- Age
- Sex
- Pack Years
- GOLD stage (Global Initiative for Chronic Obstructive Lung Disease)(post-bronchodilator FEV1)
- Number of exacerbations in the year prior to the study.
- The prescribed medication: type of inhaler, number of inhalers for maintenance treatment, number of inhalations a day.
- Number of different medications taken by the patient on a daily basis, excluding the inhalers for maintenance treatment of COPD.
Patients will fill out:
- The 12-question TAI-questionnaire (test for the adherence to inhalers)
- The COPD Assessment Test (CAT)
Intervention: The COPD Assessment Test (CAT) (Other)
Outcomes
Primary Outcomes
Adherence to inhalation medication evaluated using the Test for the Adherence to Inhalers
Time Frame: 15 minutes
Level of adherence: high (=50 points), intermediate (between 46 and 49 points) or poor (\< or = 45 points) .
Secondary Outcomes
- Type of non-adherence/ Behavioural pattern (using TAI)(15 minutes)
- Adherence in correlation to specific factors(15 minutes)
Investigators
Lisa Nicky Vancampenhout
Medical student
Universitair Ziekenhuis Brussel