Choice of device leads to better asthma control : Landmark asthma study

A landmark real-world study of more than 18,000 patients has demonstrated superior asthma control with the AeroChamber Plus* Flow-Vu* antistatic Valved Holding Chamber (VHC, or spacer) compared with other chamber devices. For those with asthma, particularly children, the choice of device to deliver their medication is an important consideration; even with the same metered-dose inhaler (MDI), not all valved holding chambers perform equally well. According to the study published in Pulmonary Therapy, the AeroChamber Plus* Flow-Vu*antistatic chamber was associated with delayed time to first exacerbation, fewer asthma-related emergency department visits, and lower exacerbation-related costs than control chambers.

Asthma is a common respiratory condition which affects more than 3 million people in Canada, and it is the most common chronic disease among children and a leading cause of hospitalizations.In Canada there were more than 70,000 emergency room visits due to asthma attacks in 2016.⁵ Mortality is high, 250 Canadians die each year from asthma and almost all of these deaths are preventable.⁶ Inhalation is the recommended route of administration for asthma medications; it provides direct targeting of drug to the lungs, and side effects are reduced compared with systemic medications. Inhaled corticosteroids (ICS) and bronchodilators administered by MDIs are the mainstay of long-term asthma treatment, the goals of which are to improve symptoms and prevent the occurrence of exacerbations.⁷ Unfortunately, poor inhaler technique is common, resulting in less of the delivered drug reaching the lungs, with much of it being deposited on the back of the throat and then swallowed.⁸ It has been found 9 out of 10 Canadians with asthma don't have their symptoms under control.⁹ Between 28% and 68% of patients do not use their inhalers well enough to benefit from the prescribed medication.¹⁰ In addition, 25% of all expenditure on inhalers is wasted due to poor inhaler technique.¹⁰

Global respiratory guidelines recommend the use of chambers to improve MDI drug delivery.⁷ The Canadian Thoracic Society and Canadian Paediatric Asthma Consensus Guidelines state the addition of a chamber is recommended and helpful.^11,12 Studies indicate that patients who use a chamber with their MDI have better asthma control than those using only a MDI.¹³ Chambers were designed to reduce the oropharyngeal deposition by changing the particle size distribution of the inhaled aerosol, and by holding the aerosol in the chamber until the patient is ready to inhale, which reduces the need for good coordination between inhalation and inhaler actuation.¹⁴ Effectiveness of these devices can be adversely affected by the design, including the chamber electrostatic charge, a commonly reported cause of inconsistent medication delivery.¹⁵

In this new study, Dr. Burudpakdee and colleagues compared the effects of the antistatic AeroChamber^* Flow-Vu* VHC and control chambers on treatment outcomes, resource use, and healthcare costs in a real-world asthma population.¹ Over 18,000 patients were included from an adjudicated claims database containing medical and pharmacy claims for more than 150 million US health plan members.¹ The analysis showed that amongst patients with at least 30 days of follow up, for those using the AeroChamber Plus* Flow-Vu* antistatic VHC time to first exacerbation was delayed, there were fewer asthma-related emergency room visits and exacerbation-related costs were lower when compared to those using the control (non-antistatic) chambers.¹ A trend towards lower exacerbation rates per patient for the AeroChamber Plus* Flow-Vu* VHC was sustained throughout the 12 months of the study.¹

"This landmark study using a large volume of real-world evidence generated from many thousands of patients shows the value of optimizing drug delivery in asthma management," said Dr. Andrew McIvor, (Firestone Institute of Respiratory Health, St. Joseph's Healthcare, Hamilton ON and past chairman of the Asthma Committee of the Canadian Thoracic Society). "The reduction in exacerbation incidence among users of the AeroChamber Plus* Flow-Vu* chamber is particularly notable, because experiencing an exacerbation is a risk factor for future exacerbation events – and minimizing exacerbation risk is a key goal of treatment in the GINA guidelines."

Co-author, Dr Jason Suggett (Group Director of Global Science and Technology, Trudell Medical International) said that the study also further supports the fact that chambers are not interchangeable. "The European Medicines Agency recommended in 2009 that development of a MDI should include the testing of at least one specific named chamber and that any substitution must be supported by appropriate in vitro or clinical data demonstrating equivalence", he commented. "We presented laboratory data at the recent Respiratory Drug Delivery Europe meeting² that confirmed that not all chambers perform equally well with the same MDI, which underlines the importance of recognizing the impact and potential risks of substituting one device for another."