Abstract
Background: The stepwise anti-inflammatory reliever (AIR) Algorithm approach to asthma management in adults is associated with enhanced patient satisfaction and improved asthma control. It is unknown whether these benefits are seen for all levels of asthma severity.
Objective: To determine whether baseline GINA-Step modifies the effect of the AIR Algorithm.
Methods: This is a secondary analysis of the 52-week AIR Algorithm single-arm study of 100 adults with asthma. Depending on baseline treatment, participants received budesonide/formoterol 200/6μg: one actuation as-needed; one actuation twice daily plus one as-needed; or two actuations twice daily plus one as-needed. Treatment step was adjusted according to frequency of reliever use and asthma attacks. This analysis explored if baseline GINA-Step was associated with different changes with time for clinical outcomes or patient satisfaction measured by the Treatment Satisfaction Questionnaire for Medication Version II (TSQM-II) using linear mixed models with interactions between GINA-Step at baseline and time of measurement.
Results: The change with time depended on baseline GINA-Step for TSQM-II Global Satisfaction: P-interaction=0.025; with the largest change for GINA Step 1 with mean (95% CI) week 52 versus baseline change, 14.3 (6.6 to 22.1), P<0.001. There was no evidence that change with time depended on baseline GINA-Step for asthma control, or other clinical outcome variables such as FEV1, FeNO and exacerbations.
Conclusion: The improvement in patient satisfaction with the AIR Algorithm differed by GINA-Step for most domain scores, with the greatest benefit in mild asthma at Step 1. There were no differences in clinical outcome variables by GINA-Step.