WHY IS ASTHMA STILL OUT OF CONTROL1

REFERENCES: 1. Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. Primary Care Respiratory Medicine (2014) 24, Article number: 14009; doi:10.1038/npjpcrm.2014.9; published online 12 June 2014 2. Crompton G, et al. A brief history of inhaled asthma therapy over the last fifty years. Prim Care Respir J. 2006 Dec;15(6):326-31 3. Demoly P, et al. Repeated cross-sectional survey of patient-reported asthma control in Europe in the past 5 years. European Respiratory Review 2012 21: 66-74; DOI: 10.1183/09059180.00008111 4. European Respiratory Society. European Lung Whitebook. http://www.erswhitebook.org/chap-ters/adult-asthma/ 5. European Federation of Allergy and Airway Diseases Patient Association: A European Patient Perspective on Severe Asthma: Fighting for Breath. http://www.efanet.org/images/2012/07/Fighting_For_Breath1.pdf Last accessed July 2017 6. Price D et al. “Inhaler errors in the CRITIKAL Study: type, frequency and association with asthma outcomes”. Journal of Allergy and Clinical Immunology: In Practice. 2017 DOI: http://dx.doi.org/10.1016/j.jaip.2017.01.004 7. Haughney J, et al. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med 2008;102:1681–93

* Devices used in the study were Symbicort Turbohaler (n=2074), Seretide Diskus (n=826) and Seretide pMDI (n=760)

2016 was the 60th anniversary since the first modern inhaler was introduced into clinical use.2 However, over the last decade studies have shown little apparent improvement in asthma control1,3

Ongoing burden of asthma

Lost productivity estimated to cost

almost €9.8bn each year 5

Asthma affects 30 million adults and children under the age of 45 in Europe4

30m

€9.8bn

Every week,

one in four people in europe with severe asthma have an

attack so intense they can’t even call out for help5

at least one person in Europe dies from asthma

And every hour,

Job code: MINT/RESP-17016Date of preparation: September 2017

• 8,000 diagnosed asthma patients aged 18-50

• 11 European countries

• REALISE survey was conducted in 2012 in asthma patients who were active on social media

• Funded by Mundipharma International Limited

REALISE study: suboptimal asthma control

Over previous year, 24% of patients

surveyed had been to an emergency department because of an asthma

exacerbation (asthma attack)1

Over the previous year,

37.5% had taken time off work due to asthma exacerbations1

Only 20% of patients had controlled asthma as defined by GINA criteria1

Despite this, 91% of respondents considered their asthma to be well controlled1

Global Initiative for

Asthma (GINA) Controlled

asthma: 20%1

Controlled asthma is

defined by GINA as no:

Day-time symptoms

Night time awakenings

Normal activities affected

Reliever inhaler needed

CRITIKAL study: errors in inhaler techniqueCRITIKAL (CRITical Inhaler mistaKes and Asthma controL)

• 3,660 patients in the iHARP asthma review service

• First study to investigate direct relationships between specific inhaler errors and asthma outcomes in patients on fixed-dose combination treatments:6

• CRITIKAL study was conducted between 2011 and 2014 and funding support was provided by Mundipharma Research Limited

A few frequent errors were common to all devices in the study*:6

Errors were assessed by fully trained

healthcare professionals

34%of people didn’t tilt

head to lift chin slightly

Between26-32%didn’t breathe out to empty lungs before inhalation

Between22-33%

didn’t hold breath for more than 3 seconds after inhalation

Patients using Symbicort® Turbohaler® or Seretide® Diskus® dry-powder inhalers6

Insufficient inspiratory effort

observed in 32% and 38%

of patients

Associated with uncontrolled asthma and increased exacerbations

25% struggled with coordination, firing device before inhalation

35% made errors relating to lack of device knowledge or incorrect second dose preparation

Patients using Seretide metered dose inhaler6

Both were associated with uncontrolled

asthma

Tackling suboptimal asthma control

Many factors are associated with poor control including adherence and inhaler technique 7

1

When assessing inhaler use, training could target the common errors associated with poor asthma control

May enable more patients in Europe to take control of their condition, in turn helping to reduce burden

of asthma and improve patient outcomes

Right inhaler

Training by healthcare

professionals+ =

3

4

It’s necessary to assess asthma accurately in clinical practice and improve patient understanding to recognise and act on symptoms and exacerbations

2