Patients with asthma who used the MASK-air app had high adherence to inhaled corticosteroids (ICS) plus long-acting β2-agonists (LABA), according to study findings published in Pulmonology.
Researchers compared adherence levels for ICS plus formoterol (ICS+F) vs ICS plus other (ICS+other) LABA in patients with self-reported asthma who used the MASK-air app. MASK-air incorporates a daily monitoring questionnaire that evaluates (1) asthma and rhinitis symptoms with 0 to 100 visual analog scales (VAS) and (2) asthma and rhinitis daily medication use.
Study participants were aged 16 to 75 years (or 13-75 years in some countries) and also reported at least 1 day of ICS+F or ICS+other LABA use. Sets of 7 consecutive days from May 2015 to December 2022 were analyzed; during these 7-day periods, patients answered the MASK-air daily monitoring questionnaire on all days.
A total of 9721 individuals using the app had self-reported asthma. Among this group, 4753 had at least 1 day of treatment: 1705 (60,521 days) reported at least 1 day of ICS+F and 893 (26,396 days) reported at least 1 day of ICS+other LABA. A total of 2598 individuals used ICS plus any kind of LABA.
The main study analysis included 4824 complete weeks of data from 621 of the individuals using ICS plus any kind of LABA (23.9%); this included 3154 weeks from 429 individuals using ICS+F and 1670 weeks from 192 individuals using ICS+other LABA. The sensitivity analysis evaluated 6444 weeks of data with 1 missing day of data at most; this analysis included 866 individuals using ICS plus any kind of LABA (34.0%), including 4272 weeks from 600 individuals using ICS+F and 2172 weeks from 266 individuals using ICS+other LABA. The participants had a mean age of 45 years.
For the primary analysis, adherence (defined as a medication possession ratio [MPR] of more than 80%) was observed during 3125 weeks (64.8%) and was greater in the ICS+other LABA group (75.1%) vs the ICS+F group (59.3%) (effect size=0.34). In 267 weeks (5.5%) of data analyzed, adherence to ICS+LABA was partial (MPR 41%-80%); in 236 weeks (4.9%), low adherence was observed (MPR 1%-40%); and in 1196 weeks (24.8%), no adherence was observed (MPR=0%).
The number of weeks with short-acting beta-agonist (SABA) use was greater among ICS+other LABA users (23.3%) compared with ICS+F users (15.5%) (effect size=0.20). In the analysis of weeks of SABA use, more days of SABA use occurred in those using ICS+other LABA (median=71.4% days) vs those using ICS+F (median=57.1% days; effect size=0.26).
Increased adherence to ICS+F or ICS+other LABA was associated with a reduction in SABA use, including after adjustment for VAS asthma levels. Each additional day per week of treatment adherence lowered the risk for weekly SABA use — by 4.1% in those using ICS+F (95% CI, -6.5% to -1.6%; P =.001) and by 8.2% in those using ICS plus other LABA (95% CI, -11.6% to -5.0%; P <.001).
Study limitations include the possibility of selection biases and reliance on the reported use of asthma medications for identifying patients with asthma. In addition, the severity of asthma, the strength of ICS plus LABA, and the number of puffs per day were not evaluated.
“Overall, this study shows the potential of mHealth tools in the longitudinal assessment of patients with asthma, allowing physicians and patients to monitor their medication adherence, control, and SABA use,” stated the investigators.
Disclosure: MASK-air has been supported by educational grants from Mylan-Viatris, ALK, GSK, Novartis, and Uriach. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Sousa-Pinto B, Louis R, Anto JM, et al. Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: a MASK-air study. Pulmonology. Published online August 3, 2023. doi:10.1016/j.pulmoe.2023.07.004