title: [Persistence to treatment by type of inhaler device in patients with asthma and chronic obstructive pulmonary disease].
abstract: OBJECTIVE
  To assess the initial treatment persistence with inhaled corticosteroids and long-acting beta-2 adrenergic bronchodilators (ICS/LABA) depending on the inhaler device used (pMDI or DPI), for the treatment of asthma and COPD.
  
  
  METHODS
  An multicenter observational study. Subjects in initial treatment with ICS/LABA during 2007-2011 were included, and a follow-up period of 3 years. 2 groups of study (asthma, COPD) and 2 subgroups were prepared according to the device type inhaler (pMDI or DPI). The main measurements were: sociodemographic, comorbidity, adherence (rate possession medication -RPM-), persistence, drugs, exacerbation rates, resources use, and their costs (direct and indirect costs). Multivariate methods were used for the variables correction, with significance level of P<.05.
  
  
  RESULTS
  The study included 2,082 asthma patients (pMDI: N = 566, 27.2%; DPI = 1,516, 72.8%). Patients with MDI devices showed a higher degree of persistence (32.5 vs. 27.8%; P=.037), treatment adherence (RPM: 83.1 vs. 80.5%; P<.001), fewer exacerbations (17.7 vs. 24.9%; P=.001) and lower health care costs (2,583 vs. 2,938 EUR; P = 0.042). 1,418 patients with COPD also were analyzed (pMDI: N = 524, 41.9%; DPI: N = 824, 58.1%) were analyzed. Patients with MDI devices also showed a higher degree of persistence (31.5 vs. 24.8%; P=.005), treatment adherence (RPM: 83.3 vs. 80.1%; P= .001), less exacerbations (40.1 vs. 48.2%; P=.002) and lower health care costs (3,922 vs. 4,588 EUR; P=.021).
  
  
  CONCLUSIONS
  pMDI devices (as ICS/LABA initial treatment) are associated with higher treatment persistence either in asthma or COPD, with lower exacerbation rates, and use of health resources and cost.
authors.affiliation: CAP Vicenç Papaciet, La Roca del Vallès (Barcelona), España. Electronic address: asicras@bsa.cat.
authors.forename: A
authors.initials: A
authors.lastname: Sicras
authors.affiliation: CAP Vicenç Papaciet, La Roca del Vallès (Barcelona), España.
authors.forename: V
authors.initials: V
authors.lastname: Ferrer
authors.affiliation: Departamento Médico, Mundipharma, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Collar
authors.affiliation: Documentación Médica, Hospital Germans Trias i Pujol, Badalona (Barcelona), España.
authors.forename: R
authors.initials: R
authors.lastname: Navarro
authors.affiliation: Research Group on Statistics, Econometrics and Health (GRECS), Universidad de Girona, Girona, España; CIBER Epidemiología/Salud Pública (CIBERESP), Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Sáez
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D058995:Dry Powder Inhalers; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D055118:Medication Adherence; D036501:Metered Dose Inhalers; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents
keywords: Asma; Asthma; Chronic obstructive pulmonary disease; Corticosteroides/beta-2 agonistas de larga duración; Corticosteroids/long-acting beta-2 adrenergic bronchodilators; Costes sanitarios; Enfermedad pulmonar obstructiva crónica; Health costs; Inhaladores; Inhalers; Persistence; Persistencia