title: Poor adherence with inhaled corticosteroids for asthma: can using a single inhaler containing budesonide and formoterol help?
abstract: BACKGROUND
  Poor adherence with inhaled corticosteroids is an important problem in asthma management. Previous approaches to improving adherence have had limited success.
  
  
  OBJECTIVE
  To determine whether treatment with a single inhaler containing a long-acting beta(2)-agonist and a corticosteroid for maintenance treatment and symptom relief can overcome the problem of poor adherence with inhaled corticosteroids.
  
  
  METHODS
  Randomised, parallel group, open-label trial.
  
  
  METHODS
  Forty-four general practices in Nottinghamshire.
  
  
  METHODS
  Participants who used less than 70% of their prescribed dose of inhaled corticosteroid and had poorly controlled asthma were randomised to budesonide 200 microg one puff twice daily plus their own short-acting beta(2)-agonist as required (control group), or budesonide/formoterol 200/6 microg one puff once daily and as required (active group) for 6 months. The primary outcome was inhaled corticosteroid dose.
  
  
  RESULTS
  Seventy-one participants (35 control, 36 active group) were randomised. Adherence with budesonide in the control group was approximately 60% of the prescribed dose. Participants in the active group used approximately 80% more budesonide than participants in the control group (448 versus 252 microg/day, mean difference 196 mug, 95% confidence interval 113 to 279; P<0.001) and were less likely to withdraw from the study (3 versus 13; P<0.01). No safety issues were identified.
  
  
  CONCLUSIONS
  Using a single inhaler for both maintenance treatment and symptom relief approximately doubled the dose of inhaled corticosteroid taken, suggesting this could be a useful strategy to overcome the problems related to poor adherence with inhaled corticosteroids.
authors.affiliation: Division of Respiratory Medicine, University of Nottingham, Nottingham City Hospital. sovani6@aol.com
authors.forename: Milind P
authors.initials: MP
authors.lastname: Sovani
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Whale
authors.forename: Janet
authors.initials: J
authors.lastname: Oborne
authors.forename: Sue
authors.initials: S
authors.lastname: Cooper
authors.forename: Kevin
authors.initials: K
authors.lastname: Mortimer
authors.forename: Tommy
authors.initials: T
authors.lastname: Ekström
authors.forename: Anne E
authors.initials: AE
authors.lastname: Tattersfield
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Harrison
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume; D000068759:Formoterol Fumarate; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D000068759:Formoterol Fumarate