Reliever inhaler use as a marker of current asthma control

Published Online: June 7, 2013

The relationship between current asthma symptoms and methods to assess rescue bronchodilator (reliever) use is uncertain. This has led to different recommendations for clinicians to follow regarding the preferred method to assess reliever inhaler use to identify the level of asthma control in their patients. In a recent six-month randomized controlled trial investigating inhaler regimens in adult asthma, data were collected on current asthma symptoms and patterns of inhaler use.

Patel et al. recently presented an analysis of these data in The Journal of Allergy and Clinical Immunology: In Practice. One hundred and fifty patients in the trial were allocated to receive an albuterol inhaler to be taken as needed for the treatment of their symptoms. In addition a combination inhaler containing budesonide and formoterol was provided for regular maintenance treatment. Electronic monitors in the inhalers measured the date and time of each inhaler actuation. The analysis was based on albuterol actuation data obtained for the seven day period prior to the clinic visit during the third week of the trial. The association between different measures of albuterol use and participants’ current asthma symptoms, as measured by the Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit, was assessed.

The number of days of albuterol use, average number of actuations per day and highest number of albuterol actuations per day over the seven day period were all comparable markers of current asthma control, with higher albuterol use being positively associated with a worse ACQ-5 score. Cut points of ≥3 days of albuterol use, average albuterol use of  ≥1 actuation per day and highest albuterol use of ≥4 actuations per day in the seven day period were best able to predict poor asthma control (an ACQ-5 score of ≥1.5).

These findings provide the evidence-base for defining patterns of reliever inhaler use as a measure of current asthma control in asthma management guidelines.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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