The Importance of Tailored Education And Device Handling for Asthmatic Patients

Overview

Significant advancements have been made in asthma medication over the past decades. Highly effective treatments are available for patients; however, both adherence and proper device usage remain below the desired levels, based on our experience and literature data. Despite the availability of numerous excellent drug-device combinations, personalized treatment for patients is still not adequately addressed. In the present study, the aim is to improve patient compliance and educate symptomatic, partially, or uncontrolled asthma patients on the correct use of a specific inhalation device (Nexthaler). Considering the characteristics of the medication, the patient's lung function data, inhalation technique, and drug retention time can help estimate the expected lung deposition of the medication. By refining the inhalation technique under the guidance of the treating physician, it is hypothesized that the expected therapeutic effects of the medication may improve.

Detailed description

Eligible Patient Population:

Patients on GINA step 2-4 therapy who are partially or uncontrolled (ACT \<25) and are receiving Foster Nexthaler® therapy as per prescribing guidelines, regardless of the study. Patients on GINA step 3 therapy receive a low-dose ICS-formoterol regimen (2x1 inhalations of Foster Nexthaler® 100/6 μg), while those on GINA step 4 receive a medium-dose ICS-formoterol regimen (2x2 inhalations of Foster Nexthaler® 100/6 μg). Whenever possible, Foster Nexthaler® 100/6 μg is used as a reliever medication following the MART principles. If the treating physician opts for salbutamol (Ventolin®, Buventol®) instead, the patient may still be included in the study, provided justification is given, considering the difficulty of training with multiple inhalation devices (pMDI and DPI with different characteristics).

Study Procedures:

Lung function tests will be performed on enrolled patients. The investigating physician will evaluate the recorded spirometry curves, which will be used for computer modeling to assess pulmonary drug deposition. The spirometry curves are also useful for evaluating the patient's condition and monitoring progress.

During the study visits (V1 - enrollment, V2 - 1 month, V3 - 3 months), the following data will be recorded: patient demographics, medical history, treatment details, risk factors, medication adherence (based on prescription refills and patient self-report), and quality of life assessment. Data collection, particularly questionnaire results, will follow the daily routine of the study center.

Study Objective:

The aim is to demonstrate that patient education on using a specific inhalation device (Foster Nexthaler®), optimizing inhalation technique (prolonging breath-hold time), and the resulting increased drug deposition lead to measurable clinical benefits, improved asthma control, and higher ACT scores.

Education on inhaler use and practicing optimal inhalation techniques are expected to improve lung function, maintain adherence, and reduce the need for rescue medication.

Primary outcome measures

• Pulmonary deposition [Time frame: 3 months]
• Asthma control questionnaire [Time frame: 3 months]

Secondary outcome measures (7)

• Asthma control [Time frame: 3 months]
• Lung function [Time frame: 3 months]
• Rescue medication [Time frame: 3 months]
• Adherence [Time frame: 3 months]
• Fractional exhaled nitric oxide [Time frame: 3 months]
• Health related quality of life [Time frame: 3 months]
• Adherence self report [Time frame: 3 months]

Eligibility criteria

Inclusion criteria

• Physician-confirmed clinical diagnosis of asthma according to GINA guidelines
• Uncontrolled asthma according to the physician's clinical assessment despite the use of appropriate therapy of Step 2 or 3, according to GINA guidelines
• Patients who are eligible for the use of Foster Nexthaler 100/6 mcg according to the SmPC
• Inhaled asthma therapy was changed independent from the study to Foster Nexthaler 100/6 mcg DPI maximum 1 week prior to OR on the day of study inclusion
• Spirometry was performed as part of routine clinical practice
• Patient able to use their Foster Nexthaler device properly after education on inhaler technique
• Patient provided written, informed consent to study participation
• Patient ≥ 18 years of age

Exclusion criteria

• Participation in any clinical trial, 30 days prior to inclusion
• Patient is unable to execute a spirometry test
• Patients hospitalized due to an exacerbation of their asthma within the last 4 weeks prior to enrolment.
• Patients with other significant diseases of the respiratory system or other organ systems that may significantly contribute to asthma symptoms (such as severe heart failure, symptomatic anaemia, functional respiratory disorders, malignant diseases etc.) according to the physician's clinical assessment.
• Continuous use of oral corticosteroids (>5 mg prednisolone/day or >4 mg methylprednisolone/day)
• Use of continuous oxygen therapy
• Use of biologics for asthma treatment
• All exclusion criteria listed in Foster Nexthaler 100/6 SmPC

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Hungary · 6 centers

• National Korányi Institute of Pulmonology — Budapest
• Department of Pulmonology and Allergology, Csornai MArgit Hospital — Csorna
• Department of Pulmonology, Debrecen University — Debrecen
• Pulmonology Outpatient Clinic of Dunakeszi — Dunakeszi
• Department of Pulmonology, University of Szeged — Szeged
• Calvinist Pulmonology Centre — Törökbálint

Identifiers

NCT: NCT06840522 · DE-HI/2024/01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗