Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects

EDUCA Group

Research output: Contribution to journalArticle

Abstract

Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.

Original languageEnglish
Article number100040
JournalWorld Allergy Organization Journal
Volume12
Issue number6
DOIs
Publication statusPublished - Jan 1 2019

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Asthma
Nijmegen Breakage Syndrome
Equipment and Supplies
Dry Powder Inhalers
Metered Dose Inhalers
Nebulizers and Vaporizers
Drug Combinations
Patient Satisfaction
Multicenter Studies
Therapeutics
Age Groups
Pharmaceutical Preparations

Keywords

  • Asthma
  • Device misuse
  • Education
  • Elderly

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pulmonary and Respiratory Medicine

Cite this

Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects. / EDUCA Group.

In: World Allergy Organization Journal, Vol. 12, No. 6, 100040, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50{\%} of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40{\%} had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43{\%} of subjects, and at least one error in using the device was registered in 56{\%} of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46{\%} to 25{\%}, and from 49{\%} to 25{\%}, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.",
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author = "{EDUCA Group} and M. Milanese and S. Terraneo and I. Baiardini and {Di Marco}, F. and A. Corsico and A. Molino and N. Scichilone and F. Albicini and A. Benfante and F. Braido and M. Caminati and Costantino, {M. T.} and M. Cottini and M. Crivellaro and {De Tullio}, R. and E. Gini and A. Grosso and G. Guarnieri and C. Lombardi and V. Patella and P. Pirina and M. Polverino and R. Raccanelli and E. Ridolo and G. Rolla and G. Steinhilber and A. Vianello",
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AU - EDUCA Group

AU - Milanese, M.

AU - Terraneo, S.

AU - Baiardini, I.

AU - Di Marco, F.

AU - Corsico, A.

AU - Molino, A.

AU - Scichilone, N.

AU - Albicini, F.

AU - Benfante, A.

AU - Braido, F.

AU - Caminati, M.

AU - Costantino, M. T.

AU - Cottini, M.

AU - Crivellaro, M.

AU - De Tullio, R.

AU - Gini, E.

AU - Grosso, A.

AU - Guarnieri, G.

AU - Lombardi, C.

AU - Patella, V.

AU - Pirina, P.

AU - Polverino, M.

AU - Raccanelli, R.

AU - Ridolo, E.

AU - Rolla, G.

AU - Steinhilber, G.

AU - Vianello, A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.

AB - Background: Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim: We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 ​years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results: A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ​± ​5 ​years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p ​< ​0.001 for both comparisons) with a significant increase of the ACT score (from 19 ​± ​4.9 to 20 ​± ​4.0, p ​< ​0.001). Conclusions: Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.

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