• Kenji Baba, Hiroyuki Tanaka, Masaki Nishimura, Norihito Yokoe, Daisuke Takahashi, Takeo Yagi, Etsuro Yamaguchi, Yuka Maeda, Tatsuya Muto, and Takaaki Hasegawa.
• Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, and Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan. baken@aichi-med-u.ac.jp
• J Aerosol Med Pulm Drug Deliv. 2011 Dec 1; 24 (6): 293-301.

BackgroundInhaled corticosteroid (ICS) therapy has improved the quality of life (QOL) for many asthmatics and reduced mortality rates associated with asthma. However, some patients do not obtain therapeutic benefit despite satisfactory adherence.ObjectivesTo determine whether asthmatic patients were using ICS devices appropriately, and to clarify relationships between these results and QOL.Subjects And MethodsWe studied 100 adult asthmatics, divided into two groups: 50 patients consecutively registered as using Diskus (fluticasone; D-group) and 50 consecutively registered as using Turbuhaler (budesonide; T-group). We measured peak inspiratory flows (PIFs) using the In-Check Dial device. Subjects also completed the Asthma Control Test for evaluation of QOL.ResultsIn the D-group, no patients showed PIF below the optimal range (30-90 L/min), whereas 52% of patients had PIF≥91 L/min. In the T-group, 6% of patients showed PIF over the optimal range (60-90 L/min), and 44% had PIF≤59 L/min. When patients in the T-group were required to deliberately make a maximal inhalation, 14% still had PIF≤59 L/min. The proportion of patients with poor control was significantly greater in the T-group than in the D-group. According to univariate logistic regression analyses, low PIF tended to be associated with poor asthma control in the T-group. No significant correlation was found between PIF and age in the D-group, but PIF decreased significantly with age in the T-group.ConclusionsAppropriate measures for patients in whom PIF has been judged as lower than optimal include adequate education for inhalation and/or changing to a different inhalation device. These measures should be kept in mind for elderly asthma patients in particular, where appropriate selection of a corticosteroid inhalation device in the early stages of therapy would also be important.

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