MART prescriptions lag among eligible patients with asthma
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Key takeaways:
- Only 15% of patients with moderate to severe asthma have a MART prescription.
- Patients with obesity, older patients and patients with Medicaid were less likely to get MART.
SAN DIEGO — Maintenance and reliever therapy is underused among patients with moderate to severe asthma, according to a study presented at the American Thoracic Society International Conference.
Multiple barriers prevent patients from receiving this treatment, Sandra Zaeh, MD, MS, pulmonary and critical care medicine physician, Yale School of Medicine, and colleagues wrote.
“As clinicians caring for patients with asthma, we noted in clinical practice that there was slow adoption of maintenance and reliever therapy (MART or SMART) for asthma, despite MART being incorporated into updated asthma management guidelines,” Zaeh told Healio.
The National Asthma Education and Prevention Program and the Global Initiative for Asthma recommend MART with inhaled corticosteroid (ICS) formoterol to manage moderate to severe persistent asthma.
However, the researchers said, many patients are not prescribed MART, or they are prescribed MART with a short-acting beta agonist (SABA) reliever, which may limit its efficacy.
“We conducted this study to assess the implementation of MART in patients with moderate to severe asthma, which confirmed our suspicion that implementation of MART has been limited to date,” Zaeh said.
“We hope that this study draws further attention to the need to better implement MART, which has been shown to reduce asthma exacerbations by over 30%,” she said.
The study comprised 2,016 adults (average age, 48.2 years; 75% women; 60.4% white) with moderate to severe asthma, including 44% who had a prescription for ICS-formoterol as a controller inhaler and 14.5% who were prescribed MART.
Also, 87% of the patients with a MART prescription additionally had a SABA reliever, even though the inhalers used in MART are designed to be used as rescue therapy too.
The patients who had a prescription for ICS-formoterol such as budesonide-formoterol (Symbicort; AstraZeneca) or mometasone-formoterol (Dulera; Merck) as a baseline controller inhaler were more likely to also have a prescription for MART (OR = 12.9; P < .001).
Older patients were less likely to have a MART prescription (OR = 0.98; P = .03). The researchers noted that providers may be less likely to try new inhaler regimens with older patients who may be more resistant to new treatment, particularly if they have been using the same inhalers for years.
Although the authors’ previous research indicated that 93% of pulmonary clinicians were aware of MART’s role in current guidelines, the current study found that 44% of academic pulmonary and allergy clinicians have not adopted it. Also, 94% of clinicians prescribed MART 30% or less of the time to patients with moderate to severe asthma.
“Additionally, clinicians who were members of an asthma subspecialty group were significantly more likely to prescribe MART than pulmonologists and allergists who were not part of the group,” Zaeh said.
The researchers noted that clinicians can take more than 15 years to widely adopt guidelines, although other barriers to MART adoption may include insurance formulary coverage and a lack of educational strategies for helping patients transition to MART.
“To expand use of MART, we believe barriers at the clinician, patient and health systems level must be addressed,” Zaeh said.
“Potential strategies include clinician education and bolstering clinician support to adopt MART through clinician decision support tools and better integration of outpatient pharmacy support,” she continued.
Zaeh also recommended developing patient education material and additional nursing support for patient education, as well as improving insurance coverage and reducing costs for ICS/formoterol to make it more accessible to all patients.
“We believe the next step is to work towards improving the implementation of MART by addressing several of the barriers listed above,” Zaeh said.
Reference:
- Few moderate or severe asthma patients prescribed recommended inhaler regimen. https://site.thoracic.org/about-us/news/2024-international-conference-press-release/few-moderate-or-severe-asthma-patients-prescribed-recommended-inhaler-regimen. Published May 21, 2024. Accessed May 21, 2024.
For more information:
Sandra Zaeh, MD, MS, can be reached at sandra.zaeh@yale.edu.