gests frequent initiation of fluticasone propionate/salmeterol (FPS). This study evaluates use of FPS and ICS and clinical outcomes in mild asthma patients.
Abstracts S265
J ALLERGY CLIN IMMUNOL VOLUME 117, NUMBER 2
Objective Measurement of Adherence with Asthma Medications B. Bender1, S. Bartlett2, C. Rand2, C. Turner3, F. Wamboldt1, L. Zhang1; 1National Jewish Medical and Research Center, Denver, CO, 2Johns Hopkins University, Baltimore, MD, 3Research Triangle Institute, Research Triangle Park, NC. RATIONALE: Objective documentation of patient adherence to asthma treatment continues to be a major challenge to clinical trials and observational studies. METHODS: One-hundred and thirty-one children with asthma requiring daily controller medication were enrolled into a 4 month study employing adherence monitoring with the Doser, MDILog, or Advair counter. RESULTS: Averaged over four months and across the three monitoring devices, adherence was 45%(SD=30). One in four children used less than 25% of their medication, and 58% used less than half. Adherence declined from the first to second month of monitoring but remained even for the following 3 months, suggesting that one-month monitoring may not pro-
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vide a fully accurate assessment of adherence. The 3 devices produced different measurement challenges and errors. Truncating data (limiting daily recorded use to no more than 100% of prescribed) produced greater accuracy for the electronic Doser and MDILog but was not possible with the mechanical Advair counter. CONCLUSIONS: Remarkably poor controller medication adherence in a community sample of children with asthma establishes again that nonadherence remains a major barrier to successful treatment. No measurement strategy has yet demonstrated complete accuracy in recording adherence behavior. Careful management of electronically recorded adherence data is necessary to reduce measurement error. Funding: National Heart, Lung, and Blood Institute Adherence with Treatment Guidelines in Mild Asthma Patients: Clinical Outcomes Associated with Fluticasone Propionate/salmeterol Vs. Inhaled Corticosteroid Therapy C. Carter1, S. Sison1, B. Yawn2, H. M. Harris1, D. Ollendorf1; 1PharMetrics, Inc., Watertown, MA, 2Olmsted Medical Center, Rochester, MN. RATIONALE: “Guidelines for the Diagnosis and Management of Asthma” (NAEPP 2004) recommend starting mild persistent asthma patients on a low-dose inhaled corticosteroid (ICS), but anecdotal clinical evidence suggests frequent initiation of fluticasone propionate/salmeterol (FPS). This study evaluates use of FPS and ICS and clinical outcomes in mild asthma patients. METHODS: Patients initiating treatment with FPS or ICS were identified from a large administrative claims database and followed for one year. A sub-cohort of mild disease severity patients was constructed using the following criteria: 1) no exacerbations requiring hospitalization, ER, or outpatient visit with nebulization or prescription for oral steroids and 2) use of no more than 2 SABA canisters six months prior to starting therapy. Clinical outcomes assessed included asthma-related outpatient/ER services, hospitalizations, and medications. Multivariate models were used to adjust for demographic and clinical differences between cohorts. RESULTS: Mild asthma was present in 45.3% of FPS patients (n=11,753) and 59.9% of ICS patients (n=23,580). Demographics were comparable between cohorts. Mean age was 36.9 (FPS) and 36.0 (ICS) years. Most patients were female (61.3% FPS, 63.5% ICS). FPS patients filled 12% fewer rescue medication prescriptions (p
