HFA Beclomethasone in Asthma, a General Practice Research Database Study: Real-life Observational Evaluation of Extra-fine With Standard Particle Size Beclometasone Dipropionate Using the Propellant Hydrofluoroalkane 134a for the Management of Asthma in a Representative UK Primary Care Population
Overview
- Phase
- Not Applicable
- Intervention
- extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
- Conditions
- Asthma
- Sponsor
- Research in Real-Life Ltd
- Enrollment
- 56985
- Locations
- 1
- Primary Endpoint
- Severe asthma exacerbation (ATS/ERS based defn)
- Status
- Completed
- Last Updated
- 13 years ago
Overview
Brief Summary
This study will compare the absolute and relative effectiveness of asthma management in patients on inhaled corticosteroid (ICS) maintenance therapy as either extra-fine-particle or larger-particle formulation beclomethasone dipropionate (BDP) via metered-dose inhalers (MDIs) using the propellant hydrofluoroalkane propellant (HFA-BDP), namely Qvar® MDI compared with Clenil® MDI.
Detailed Description
Current asthma guidelines in the UK are underpinned by evidence derived from randomised controlled trials (RCTs). Although RCT data are considered the gold standard, patients recruited to asthma RCTs are estimated to represent less than 10% of the UK's asthma population. The poor representation of the asthma population is due to a number of factors, such as tightly-controlled inclusion criteria for RCTs. There is, therefore, a need for more representative RCTs and real-life observational studies to inform existing guidelines and help optimise asthma outcomes. In response to the Montreal Protocol's ruling to phase out ozone-depleting chlorofluorocarbon (CFC) propellants in asthma inhalers, several hydrofluoroalkane-134a-propellant (HFA-) formulations of BDP have been developed. Two branded generic formulations currently available in the UK are Qvar® (Teva Pharmaceutical Industries Ltd) - an extra-fine-particle (\~1.1 microns) HFA-BDP (solution) formulation and Clenil® (Chiesi Limited) - a larger particle (\~2.9 microns) HFA-BDP (suspension) formulation. The extra-fine particle formulation HFA-BDP formulation (Qvar®) has been shown to improve total and small airway deposition relative to CFC-BDP. As a result of the more even distribution through both the large and small airways of the lungs and data from short-term randomised clinical trials (RCTs), Qvar® dosing is recommended at approximately one half the dose of traditional CFC-BDP (average particle size \~3.5 microns). However, the larger-particle Clenil® is recommended for prescribing at the same dose as traditional CFC-BDP. Further studies are required to understand whether the differences in particle size and airway distribution have an impact on asthma outcomes over the long-term. This observational study will investigate the real-world effectiveness of extra-fine HFA-BDP (Qvar®) as compared with larger-particle HFA-BDP (Clenil®) in patients with asthma who: were new to ICS therapy; received an increase in their ICS dose, or switched / changed baseline ICS therapy to HFA-BDP with no change in BDP-equivalent ICS dose. We hypothesise that differences in effectiveness might become apparent over the longer term through a retrospective database analysis of one-year outcomes for the diverse patient population seen in primary care.
Investigators
David Price
Professor David Price
Research in Real-Life Ltd
Eligibility Criteria
Inclusion Criteria
- •Aged: 4-80 years
- •Paediatric cohort (aged 4-11 years), and
- •Adult cohort (aged 12-80 years )
- •Evidence of asthma and current asthma therapy:
- •All cohorts (IPDI, IPDS, IPDA):
- •a diagnostic code for asthma, and / or \*≥2 prescriptions for asthma at different points in time during the prior year and/or IPDI only: ≥2 prescriptions for asthma therapies during the outcome year, including ≥1 ICS prescription in addition to that received at IPD
- •IPDA and IPDS only:
- •1 ICS prescription in the baseline year, and
- •1 other asthma prescription during the baseline year.
- •\*Evidence of "current therapy":
Exclusion Criteria
- •Had a COPD read code at any time; and/or
- •Had any chronic respiratory disease, except asthma, at any time; and/or
- •Patients on maintenance oral steroids during baseline year
- •Received a combination inhaler in addition to a separate ICS inhaler in the baseline year; and/or
- •Received ICS therapy during baseline year via DPI (IPDA and IPDS cohorts only).
- •If they received multiple ICS prescriptions on the same day at IPD or immediately before
Arms & Interventions
IPDI EF HFA-BDP
Patients initiating inhaled corticosteroid therapy as extra-fine HFA-BDP MDI at the index date
Intervention: extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
IPDI SP HFA-BDP
Patients initiating inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date
Intervention: standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
IPDA SP HFA-BDP
Patients increased inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date
Intervention: standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
IPDA EF HFA-BDP
Patients increased inhaled corticosteroid therapy as extra fine particle HFA-BDP MDI at the index date
Intervention: extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
IPDS SP HFA-BDP
Patients increased inhaled corticosteroid therapy as standard particle HFA-BDP MDI at the index date
Intervention: standard particle particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
IPDS EF HFA-BDP
Patients increased inhaled corticosteroid therapy as extrafine particle HFA-BDP MDI at the index date
Intervention: extra fine particle hydrofluoroalkane beclomethasone dipropionate via metered dose inhaler
Outcomes
Primary Outcomes
Severe asthma exacerbation (ATS/ERS based defn)
Time Frame: 1 year
Exacerbation defined as: (i) Respiratory-related: 1. Hospital attendance / admissions OR 2. A\&E attendance OR (ii) Use of acute oral steroids\*\*
Primary composite asthma control
Time Frame: 1 year
Where control is defined as absence of: (i) Respiratory-related: 1. Hospital attendance or admission 2. A\&E attendance, OR 3. Out of hours attendance, OR 4. Out-patient department attendance (ii) GP consultations for lower respiratory tract infection (iii) Prescriptions for acute courses of oral steroids
Secondary Outcomes
- Exacerbation definition based on clinical experience(1 year)
- Asthma control + SABA usage(1 year)
- Treatment success(1 year)
- Asthma-related hospitalisations(1 year)
- Respiratory hospitalisations(1 year)
- SABA usage(1 year)
- ICS compliance(1 year)
- Oral Thrush(1 year)