Effectiveness of inhaled therapies in asthma among adults in Northern Sri Lanka, a low-income and middle-income country: a prospective observational study.
Yalini Guruparan, Thiyahiny S Navaratinaraja, Gowry Selvaratnam, Shalini Sri Ranganathan
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引用次数: 0
Abstract
Background: Inhaled corticosteroids (ICS) alone, or combined with long-acting beta2-agonist (LABA), are recommended for chronic asthma. Limited access to inhaled medications hinders effective control of asthma in low-income and middle-income countries.
Objective: This study aimed to compare the effectiveness of inhaled therapies in a cohort of adult patients with asthma who were receiving treatment in a tertiary hospital in Northern Sri Lanka.
Methods: A prospective cohort study was conducted among adult patients with asthma on either ICS alone or ICS/LABA combination for at least 3 months. Participants were followed up for 6 months, with two follow-up interviews conducted 3 months apart. The primary outcome measure was asthma control, assessed by a locally validated asthma control patient-reported outcome measure. Secondary outcome measures included the use of short-acting beta2-agonists (SABA) and the percentage of patients required nebulisations and hospitalisations. McNemar's test was used to determine the statistical significance. A p value≤0.05 was considered significant.
Results: Of the 1094 participants, 827 (76%) were on ICS monotherapy and 267 (24%) were on ICS/LABA. Though there were no changes in the treatment, progressive improvement in asthma control was observed from baseline to second follow-up in both ICS (54%-72%) and ICS/LABA (76%-81%) groups. Significant improvement in asthma control (p<0.001) and SABA overuse (p<0.001) at both follow-ups and nebulisation (0.008) at the first follow-up were observed in the ICS group.
Conclusion: Both ICS monotherapy and ICS/LABA were effective in controlling asthma. Though control was greater with ICS/LABA, the effect of additional monitoring during the follow-up was higher and significant in ICS monotherapy. Considering the low access to ICS/LABA, a treatment package comprising ICS plus non-pharmacological approaches could be a more realistic and cost-effective treatment strategy in the local context. ICS/LABA could be reserved for patients who fail to respond. However, this observation needs to be confirmed by interventional studies.
期刊介绍：
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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