Thomas Mike, Haughney John, Price David
Centre of Academic Primary Care, School of Medicine and Dentistry, University of Aberdeen, Foresterhill Health Centre, Aberdeen, UK.
Pragmat Obs Res. 2011 Dec 15;2:25-31. doi: 10.2147/POR.S24674. eCollection 2011.
Recent real-world studies have demonstrated that asthma control remains suboptimal in many patients. The aim of this study was to evaluate physicians' perceptions of the effectiveness of combination therapy with an inhaled corticosteroid (ICS) and a long-acting β-agonist (LABA) in routine clinical practice.
In November 2009, UK respiratory specialists were invited by medeConnect Healthcare Insight to complete a survey on the effectiveness of different single- or dual-inhaler combinations of an ICS and a LABA in the context of asthma management. Respondents were permitted to specify combinations of available ICSs and LABAs, based on their knowledge and experience of the individual components. Questions elicited both unprompted free-text responses and prompted responses selected from a list of options.
A total of 98 physicians completed the survey, of whom 82 (84%) gave permission to publish their data. The majority of respondents (63%) were consultants and 57% reported a caseload of more than 40 patients with asthma or chronic obstructive pulmonary disease per month. Fluticasone and formoterol were considered to be the most effective combination for the treatment of asthma (37% unprompted, 41% prompted), followed by budesonide and formoterol (22% unprompted, 24% prompted). The most common reasons for choosing specific combinations were: rapid onset of action (60%), high potency of the ICS (39%), efficacy (15%), experience of prescribing (13%), clinical evidence (12%), and long-lasting effect (10%). Key properties of the preferred fluticasone and formoterol combination were rapid onset of action and high potency of the ICS (79% for both).
The results of this survey suggest that the ICS and LABA combination considered most effective by UK physicians in the management of asthma is fluticasone and formoterol, which is not currently available as a single-inhaler combination. The development of new single-inhaler combinations of ICSs and LABAs may improve real-world asthma management.
近期的真实世界研究表明，许多患者的哮喘控制仍未达到最佳状态。本研究的目的是评估医生对吸入性糖皮质激素（ICS）和长效β受体激动剂（LABA）联合治疗在常规临床实践中的有效性的看法。
2009年11月，medeConnect Healthcare Insight邀请英国呼吸科专家完成一项关于ICS和LABA不同单吸入器或双吸入器组合在哮喘管理中的有效性的调查。受访者可根据其对各个成分的了解和经验，指定可用的ICS和LABA的组合。问题引发了无提示的自由文本回答以及从选项列表中选择的提示性回答。
共有98名医生完成了调查，其中82名（84%）允许公布其数据。大多数受访者（63%）是顾问，57%报告每月有超过40例哮喘或慢性阻塞性肺疾病患者。氟替卡松和福莫特罗被认为是治疗哮喘最有效的组合（无提示37%，提示41%），其次是布地奈德和福莫特罗（无提示22%，提示24%）。选择特定组合的最常见原因是：起效迅速（60%）、ICS效力高（39%）、疗效（15%）、处方经验（13%）、临床证据（12%）和作用持久（10%）。首选的氟替卡松和福莫特罗组合的关键特性是起效迅速和ICS效力高（两者均为79%）。
本次调查结果表明，英国医生认为在哮喘管理中最有效的ICS和LABA组合是氟替卡松和福莫特罗，目前尚无单吸入器组合剂型。开发新型ICS和LABA单吸入器组合可能会改善真实世界中的哮喘管理。
