Patient experiences of as-needed budesonide-formoterol by Turbuhaler® for treatment of mild asthma; a qualitative study

J M Foster; R Beasley; I Braithwaite; T Harrison; M Holliday; I Pavord; H K Reddel

doi:10.1016/j.rmed.2020.106154

Patient experiences of as-needed budesonide-formoterol by Turbuhaler® for treatment of mild asthma; a qualitative study

Respir Med. 2020 Dec:175:106154. doi: 10.1016/j.rmed.2020.106154. Epub 2020 Sep 13.

Authors

J M Foster¹, R Beasley², I Braithwaite³, T Harrison⁴, M Holliday⁵, I Pavord⁶, H K Reddel⁷

Affiliations

¹ Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. Electronic address: j.m.foster@woolcock.org.au.
² Medical Research Institute of New Zealand, Wellington, New Zealand. Electronic address: richard.beasley@mrinz.ac.nz.
³ Medical Research Institute of New Zealand, Wellington, New Zealand. Electronic address: Irene.Braithwaite@mrinz.ac.nz.
⁴ Nottingham Respiratory Medicine Unit and NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK. Electronic address: tim.harrison@nottingham.ac.uk.
⁵ Medical Research Institute of New Zealand, Wellington, New Zealand. Electronic address: Mark.Holliday@mrinz.ac.nz.
⁶ Respiratory Medicine Unit, Oxford Respiratory NIHR Biomedical Research Centre, University of Oxford, Oxford, UK. Electronic address: ian.pavord@ndm.ox.ac.uk.
⁷ Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. Electronic address: helen.reddel@sydney.edu.au.

PMID: 33190085
DOI: 10.1016/j.rmed.2020.106154

Abstract

Background: Combination low-dose budesonide-formoterol, taken as-needed for symptom relief reduces exacerbation risk and is recommended for treatment of mild asthma. The NovelQ qualitative study explored patients' attitudes toward using this novel therapy.

Methods: Adults with mild asthma using reliever-only treatment were randomised to as-needed budesonide-formoterol Turbuhaler® in a multinational, 52-week open-label randomised controlled trial (NovelSTART-ACTRN12615000999538). A subgroup were interviewed to explore their attitudes to use of as-needed budesonide-formoterol after receiving it for ≥10 months. Semi-structured interviews were conducted until saturation, audio-recorded, and thematically analysed.

Results: Analysis of 35 participants (66% female; mean age 43.5 [range 18-74]; mean Asthma Control Questionnaire score 1.09 ± SD0.55) interviews identified 5 themes, each including both barriers and facilitators to therapy use. Themes were: 'Treatment effectiveness' i.e. how well symptoms were relieved and/or prevented; 'Lifestyle fit of the regimen' e.g. the extent to which the treatment regimen integrated into the patient's daily life; 'Attitudes toward medication use and safety' e.g. openness for new reliever treatments, beliefs about treatment necessity or side effects; 'Device attributes' e.g. perceived ease of use; and 'Doctor-patient relationship' e.g. impact of health professional support on new treatment acceptance.

Conclusions: A wide range of factors seem to drive the opinions of mild asthma patients on as-needed budesonide-formoterol therapy. Many patients perceived both positive and negative treatment attributes, and their individual evaluation of these attributes determined their likelihood of using it after the study. Supportive patient-physician interactions appear key to addressing patient barriers. Recommendations for patient-centred discussions, developed from this research, are provided.

Keywords: Asthma; Drug combinations; Medication adherence; Mild asthma; Patient preference; Physician-patient relations; Qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Inhalation
Adolescent
Adult
Aged
Asthma / drug therapy*
Asthma / psychology*
Attitude to Health
Budesonide, Formoterol Fumarate Drug Combination / administration & dosage*
Female
Humans
Male
Medication Adherence
Middle Aged
Nebulizers and Vaporizers*
Patient Preference
Physician-Patient Relations
Qualitative Research*
Randomized Controlled Trials as Topic
Severity of Illness Index
Young Adult

Substances

Budesonide, Formoterol Fumarate Drug Combination