Adherence to Adding ICS to Rescue Therapy in a Pragmatic Trial with Adults with Asthma– a Pilot Study
Monday, March 5, 2018
South Hall A2 (Convention Center)
Juan Carlos Cardet, MD, MPH, Paula J. Busse, MD FAAAAI, Jennifer K. Carroll, MD, MPH, Thomas B. Casale, MD FAAAAI, Tamera Coyne-Beasley, MD MPH, Maureen Fagan, DNP, MHA, FNP-BC, Victoria E. Forth, PA-C, Anne L. Fuhlbrigge, MD MS, Michelle L. Hernandez, MD FAAAAI, David Kaelber, MD, PhD, MPH, MS, Barbara Kaplan, MPH, CHES, Margarita Lorenzi, BS, Suzanne Madison, PhD, MPH, MPA, Nancy E. Maher, MPH, Karen Majewski, RN CNP, Brian Manning, MPH, CHES, Melissa D. McKee, MD, Sylvette Nazario, MD, Wilson D. Pace, MD, Michael J. Pencina, PhD, Cynthia S. Rand, PhD, Jacqueline Rodriguez-Louis, MPH, MEd, Lilin She, PhD, Joel Shields, MA, Jessica E. Teng, MPH, Michael E. Wechsler, MD MMSc, Juan P. Wisnivesky, MD, DrPH, Barbara P. Yawn, MD MSc FAAFP, Elliot Israel, MD FAAAAI

Using inhaled corticosteroids (ICS) concomitantly with rescue inhalers (Patient-Activated Reliever-Triggered ICS; ‘PARTICS’) reduces asthma exacerbations in efficacy trials, but has not been tested in pragmatic trials with highly-impacted asthma populations. We conducted a pilot to determine our ability to execute PARTICS in a pragmatic trial with African-American/Black and Hispanic/Latino participants.


Four sites recruited 31 adults with asthma, randomized ~3:1 to intervention or usual care, and followed for 3 months. All participants received guideline-based educational videos on recognizing and treating asthma symptoms, and a rescue inhaler storage pouch. Intervention participants also received video-based instructions on implementing PARTICS in addition to usual medications. Monthly questionnaire timeliness (due date +/-15 days) was monitored. Participants were interviewed by phone at 1, 6 and 12 weeks post-enrollment.


Timely questionnaire response rates were 61%, 61%, 71% at months 1-3, respectively. Self-reported adherence to PARTICS (i.e., “using ICS and rescue inhalers together”) was 76%, 88%, and 62% (95%CI 60-92%(n=26), 75-100%(n=23), and 40-84%(n=18) at months 1-3, respectively). Barriers to completing study procedures included having difficulty with log-in access to electronic questionnaires (30%, 38% at 6, 12 weeks, respectively), remembering to use ICS and rescue inhalers together (20%), and obtaining refills (19%). Only 22% of participants recognized their short-acting bronchodilator under the terms “reliever” or “rescue”.


The PARTICS concept was easily assimilated by participants, although adherence appeared to decrease over time. Adoption of common rescue inhaler nomenclature is not widespread amongst our population. Questionnaire completion was suboptimal and requires facilitation. Pilot study results have modified the full study protocol.