Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chan IC(1), Wong KL(2), Chu MW(1), Ng TM(1), Leung YS (1)
Affiliation :
(1) Department of Pharmacy, Queen Elizabeth Hospital, (2)Department of Paediatrics, Queen Elizabeth Hospital
Introduction :
The use of single maintenance and reliever inhaler therapy (SMART) with an inhaled corticosteroid (ICS)-formoterol combination inhaler is an approach recommended by the Global Initiative for Asthma (GINA). SMART is preferred over alternative treatment regimens for asthma treatment and management. The use of ICS can target the pathophysiology of asthma and incorporation of ICS-formoterol can reduce patient reliance on short-acting beta-agonist as a reliever, which improve long-term asthma control and reduce risk of severe exacerbation.
Objectives :
To investigate if the use of SMART regime can improve asthma control, quality of life, inhaler technique, and compliance.
Methodology :
This was a single-centre, prospective study. Patients aged 12-18 years who require GINA step 3 or above treatment were recruited. Eligible patients were switched from their initial controller and alternative reliever to SMART. Data was recorded at study entry, 4 weeks and 12 weeks. The primary outcome was the measure of asthma control reflected by the change in the number of mild exacerbation days. Secondary outcomes include the change in asthma-related symptoms, biochemical markers of immunoglobulin E (IgE) and eosinophil count, asthma control test (ACT) scores, pediatric quality of life questionnaire (PAQLQ) scores, compliance, and inhaler technique scores.
Result & Outcome :
A total of eight patients were recruited over seven months. Median mild exacerbation days dropped from 2.50 days per 4 weeks at baseline to 0.00 at both week 4 (p = 0.027) and week 12 (p = 0.732). The mean ACT scores improved from 19.50 to 23.13 at week 4 (p = 0.002) and dropped to 21.75 at week 12 (p = 0.451). Breathlessness and cough were the only asthma symptom that was significantly reduced by week 4. The composite outcome of total symptomatic days went from 10.38 per 4 weeks at week 0 to 2.75 and 3.56 at week 4 (p = 0.041) and 12 (p = 0.582). Similarly, reliever use also declined. SMART practise was not found to be associated with significant improvements in asthma-specific quality of life, inhaler technique, and compliance. SMART led to a significant reduction in exacerbations and improvement in asthma control and symptoms in the local adolescent population after 4 weeks. In spite of the small-scale study, our results still echo the recommendations made by GINA, and it served as preliminary evidence indicating the potential of improvement in asthma control by the adoption of SMART practice.
