title: Establishing the relationship of inhaler satisfaction, treatment adherence, and patient outcomes: a prospective, real-world, cross-sectional survey of US adult asthma patients and physicians.
abstract: BACKGROUND
  Inhaled asthma medications are the mainstay of treatment for chronic asthma. However, nonadherence rates for long-term inhaler therapy among adults are estimated to exceed 50 %. Nonadherence is associated with unfavorable clinical outcomes and diminished quality of life. Research suggests that adherence is associated with patients' satisfaction with their treatment regimen and other factors, such as concomitant allergic rhinitis and tobacco use.
  
  
  METHODS
  This prospective, cross-sectional survey of physicians and their patients evaluated the relationship between patient satisfaction with attributes of inhaler devices, treatment adherence, and clinical outcomes. Primary care and specialist physicians completed a physician-reported patient record form for patients with a confirmed asthma diagnosis. Patients for whom a physician-reported form was completed were invited to complete a patient-reported form. Both surveys collected information about demographics, symptoms, exacerbation history, treatment, smoking status, comorbidities, type of inhaler device, and treatment adherence. Patients also indicated the degree to which they were satisfied with attributes of their currently prescribed inhaler device(s). Partial least squares path modeling quantified relationships between latent variables and clinical outcomes.
  
  
  RESULTS
  A total of 243 patients were included in our analysis and 41 % had poorly controlled asthma. More favorable clinical outcomes were significantly associated with greater patient satisfaction with drug delivery (P = 0.002), higher medication adherence (P = 0.049), no history of tobacco use (P < 0.001), and absence of comorbid allergic rhinitis (P = 0.005). Attributes associated with device satisfaction included patient perceptions of consistency in the amount of drug delivery to the lungs, ease of use, and feedback about the number of remaining doses.
  
  
  CONCLUSIONS
  Higher patient satisfaction with their asthma drug delivery inhaler device is a significant predictor of more favorable clinical outcomes while allergic rhinitis and smoking history were negatively associated with optimal control of asthma. These findings provide clinicians with opportunities to improve patients' clinical outcomes by tailoring choice of inhaler device therapy and providing education about the correct way to use the device to ensure optimal outcomes. Patients will likely benefit from medical therapy to manage comorbid allergic rhinitis and smoking cessation interventions. Patients unable to stop smoking may require alternative medical therapies to improve their clinical outcomes.
authors.affiliation: Professor of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Meda Pharmaceuticals, 265 Davidson Avenue, Suite 400, Somerset, NJ 08873-4120 USA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Harrow
authors.affiliation: Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Small
authors.affiliation: Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB UK.
authors.forename: James
authors.initials: J
authors.lastname: Pike
authors.affiliation: Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, Cheshire, SK10 5JB UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Higgins
keywords: Adherence; Allergic rhinitis; Asthma; Inhaler device; Patient outcomes; Treatment satisfaction