‘Very simple intervention’ improves asthma care among Black, Hispanic patients

PHOENIX — A new strategy for administering inhaled corticosteroids improved asthma control among Black and Hispanic patients, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Black and Hispanic patients experience more than twice as many ED visits as well as deaths due to asthma as white patients, and efforts to reduce these rates have been expensive, difficult and mostly unsuccessful, the researchers said.

“It’s a health disparity. It’s a minority health issue. These are populations where no intervention is big enough to push the needle closer to equity,” Juan Carlos Cardet, MD, assistant professor of internal medicine in the department of allergy and immunology at University of South Florida Morsani College of Medicine, told Healio.

“Having said that, there’s no reason to think that this intervention is going to be exclusive to Black or Latinx populations. In fact, we hope that this is something that can help any population regardless of race or ethnicity,” Cardet said.

A patient-centered intervention

The researchers noted that as-needed inhaled corticosteroid (ICS) strategies are the cornerstone of asthma control therapies, but adherence is low, with data suggesting refill rates as low as 25%. Symptom-driven use, the researchers continued, could improve asthma outcomes.

The PREPARE study tested the Patient-Activated Reliever-Triggered Inhaled Corticosteroid Strategy (PARTICS) among 603 Black and 598 Hispanic/”Latinx” patients, aged 18 to 75 years, with moderate to severe persistent asthma. These participants all had scores of less than 20 on an Asthma Control Test (ACT) or an exacerbation in the previous year.

Researchers randomly assigned patients to usual care alone (n = 601; mean age, 47 years; 82.7% women) or to the PARTICS cohort (n = 600; mean age, 48.3 years; 84.7% women), which involved a patient-activated, reliever-triggered ICS strategy that involved 80 µg of beclomethasone dipropionate.

Patients in the intervention group attended one instructional visit where they learned how to use PARTICS. They were told to take one puff of ICS every time they used a beta-agonist and five puffs every time they used a nebulizer for their asthma symptoms, in addition to continuing their usual care. Patients also answered 15 monthly questionnaires.

“In consultation with our patient partners, we created study materials including videos. Both arms had instructional videos. They were created in English and Spanish,” Cardet said.

“During the study visit, patients would watch the videos. Additional questions were addressed by the study coordinators, and then patients were entered into the trial,” he added.

Impact on asthma outcomes

The annualized rate of severe asthma exacerbations served as the study’s primary endpoint.

Median follow-up was 14.9 months.

Results — simultaneously published in The New England Journal of Medicine — showed that when added to usual care, PARTICS reduced severe asthma exacerbations by 15.4% (HR = 0.85; 95% CI, 0.72-0.99), or by 13 exacerbations per 100 patient-years. The annualized rate of severe asthma exacerbations was 0.69 (95% CI, 0.61-0.78) in the PARTICS group vs. 0.82 (95% CI, 0.73-0.92) in the usual care group.

The combination of PATRICS and usual care also improved ACT scores by 3.37 points from baseline, compared with an improvement of 2.53 points in the usual care group (P < .0001).

ACT scores also improved by 3 points or more from baseline during 11.8% more study months for patients who received PARTICS and usual care, compared to those who only received usual care (P = .006).

Asthma Symptom Utility Index scores improved by 0.12 points among the participants receiving PARTICS and UC, compared to an improvement of 0.08 points among those only on usual care (P < .0001).

Further, the participants receiving PARTICS and usual care saw 3.33 fewer days of missed work, school or usual activities than those on usual care alone (13.4 days vs. 16.8 days; rate ratio = 0.8; 95% CI, 0.67-0.95).

The PARTICS and usual care cohort refilled their ICS prescriptions 1.1 times more for the year as well (8.9 vs. 7.8 inhalers per year). The intervention group reported fewer refills of their quick-reliever metered-dose inhaler (4.6 vs. 5.6 refills) and fewer months in which they used their quick-reliever nebulizer (3.6 vs. 5.4 months).

Greater implementation

The patient-centered, one-time instruction in PARTICS led to minimized additional ICS use while substantially reducing asthma exacerbations and improving asthma control and quality of life among Black and Hispanic adults with poorly controlled asthma, the researchers concluded.

Cardet encouraged doctors to communicate with their patients and emphasize the need for adherence to treatment.

“It’s a very simple intervention. Keep doing whatever it is that you’re giving your patient in terms of control therapy. For every time that your patient uses rescue therapy either in the form of a puffer or a nebulizer, ask them to puff themselves with an inhaled corticosteroid,” Cardet said.

The researchers aim to continue their work and promote the intervention so it sees greater use.

“We’re going to apply for an implementation grant. Now it’s a matter of how we get this into guidelines. How do we get this into clinics? How do we get this on the street? How do we get this implemented and adopted into a health care system?” Cardet said.

“That’s going to be the sort of thing that we look at from now on. In a broad health care system, once you tell physicians about it, do they remember that it is something they want to do? Are the systems in place so that both physicians and patients adopt it?” Cardet said.

Yet Cardet remained optimistic about the results and the intervention’s potential impact.

“One in-person study visit was able to provide results all pointing in the same direction of reductions in asthma exacerbations, improving asthma control and quality of life, and reducing number of days lost from asthma,” Cardet said. “As suggested, it’s easy to incorporate.”

References:

• Israel E, et al. N Engl J Med. 2022;doi:10.1056/NEJMoa2118813
• Patient-centered intervention improved asthma outcomes for Black and Latinx adults. https://www.eurekalert.org/news-releases/944552. Published Feb. 26, 2022. Accessed Feb. 27, 2022.