Article Figures & Data
Figures
- Figure 1.
Forest plot comparing participants who use nonstandard versus standard asthma inhaler names using multivariable regression models and controlling for age, gender, ethnicity, BMI, region, smoking environment, years diagnosed with asthma, and asthma controller regimen. Incidence rate ratios (for ED/UC visits and steroid bursts) and odds ratios (for hospitalizations) (all outcomes denoted by the blue diamonds), their 95% confidence intervals (denoted by the red lines with whiskers) and p-values are shown for each outcome. Abbreviations: BMI, body mass index; ED, emergency department; UC, urgent care.
Tables
All Inhalers (Both Controller and rescue therapy inhalers) Non-Standard Inhaler Names (n = 502)
(44% of participants used non-standard names for either controller or rescue inhalers or for both)Standard Inhaler Names (n = 648)
(56% of participants used standard names for both controller and rescue inhalers)Controller therapy inhalers Non-Standard Controller Inhaler Names (n = 335)
(29% of participants used non-standard names for controller inhalers)Standard Controller Inhaler Names (n = 815)
(71% of participants used standard names for both controller and rescue inhalers)Color 174 Brand or generic name 654 Delivery device type (e.g., puffer, disc, “pompa,” etc.) 117 Unique name (e.g., “Get it,” “Friend,” etc.)** 44 Inhaler type (i.e., “controller”) 161 Rescue therapy inhalers Non-Standard Rescue Inhaler Names (n = 407)
(35% of participants used non-standard names for controller inhalers)Standard Controller Rescue Names (n = 743)
(65% of participants used standard names for both controller and rescue inhalers)Color 144 Brand or generic name 528 Delivery device type (e.g., puffer, disc, “pompa,” etc.) 234 Unique name (e.g., “Bob,” “Lifeline,” etc.)# 29 Inhaler type (i.e., “rescue”) 215 ↵Notes: *A participant was considered to use non-standard inhalers names if he/she used a non-standard name for either a controller or rescue therapy inhaler or for both; a participant was considered to use standard inhalers names if he/she used standard names for both controller and rescue therapy inhalers. **Other unique controller inhaler names included “Buddy,” “El de la casa,” “The Q,” “Relaxing” and “Savior.” #Other unique rescue inhaler names included “Breath of life,” “Helper,” “Keep me alive,” “Mi salvación,” and “My baby.”
Characteristics Overall (n = 1150) Inhaler Names Non-Standard Names (n = 502) Standard Names (n = 648) p-Value Demographic Age 48.2 (13.8) 48.3 (13.1) 48.1 (14.3) 0.853 Gender Women 83.6% 83.1% 84.0% 0.689 Ethnicity and race* Non-Latinx Black 50.4% 55.8% (280) 46.3% (300) 0.006 Caribbean Latinx 38.1% 34.5% (173) 40.9% (265) Other Latinx 11.5% 9.8% (49) 12.8% (83) Language Spanish 21.9% 24.1% 20.2% 0.114 Region** Northeast 40.3% 28.7% 49.2% <0.001 Ohio Valley Central 14.5% 16.3% 13.1% Puerto Rico 8.5% 10.4% 7.1% Southeast 30.9% 38.4% 25.0% Southwest 5.8% 6.2% 5.6% Socioeconomic Highest Education level Less than high school 13.9% 15.2% 12.8% 0.306 High school, some college or tech school 55.6% 54.2% 56.8% College or graduate school 30.5% 30.7% 30.4% Total yearly household income? Less than $10,000 25.8% 29.3% 23.1% 0.076 $10,000 to $40,000 36.3% 36.9% 35.9% >$40,000 19.9% 19.0% 20.5% Prefer not to answer 18.1% 14.9% 20.5% Health Literacy (BHLS) High 83.0% 83.9% 82.3% 0.471 Clinical BMI 35.0 (9.2) 35.1 (9.3) 34.9 (9.2) 0.758 Comorbidities# 0 29.4% 30.7% 28.4% 0.230 1+ 69.7% 69.0% 70.0% Missing 1.0% 0.2% 1.5% Lives in smoking environment 22.1% 24.9% 19.9% 0.043 Age diagnosed with asthma Less than 12 years 41.4% 41.6% 41.4% 0.547 12 years or more 49.4% 49.0% 49.9% Missing 9.0% 9.4% 8.8% Years with asthma 0 to 10 years 22.0% 25.5% 19.5% 0.012 More than 10 years 69.7% 65.3% 73.0% Missing 8.3% 9.2% 7.6% Use a nebulizer as rescue med? Yes 66.7% 67.9% 65.7% 0.435 Baseline controller therapy regimen ICS only 17.0% 17.3% 16.8% 0.033 ICS + 1+ controllers 80.0% 78.9% 80.8% Regimen includes biologic 3.0% 3.8% 2.3% BMQ Subgroup High necessity, high concern 35.1% 35.7% 34.7% 0.975 High necessity, low concern 54.4% 54.0% 54.8% Low necessity, high concern 1.7% 1.6% 1.9% Low necessity, low concern 8.7% 8.8% 8.6% Low self-reported adherence to asthma medications% 52.7% 52.6% 52.8% 0.95 Notes: Categorical data are presented as percentages, continuous data are presented as means (standard deviation). P-values correspond to the comparison between values for standard versus non-standard names using Student’s t test or χ2 test, as appropriate. *Since the term “Latinx” refers to an ethnicity with shared language and not a race,26 individuals who self-reported to be both Latinx and Black were considered Latinx in the PREPARE study. “Caribbean Latinx” includes individuals who self-reported to be Puerto Rican, Dominican or Cuban; “Other Latinx” includes individuals who self-reported to be Mexican, Central or South American or Spaniard. **These regions are reflective of the location of the PREPARE study recruitment clinical sites and are not meant to encompass all possible regions of the US. #Medical comorbidities include heart disease, cancer [excluding non-melanoma skin], stroke, diabetes, chronic kidney disease, COPD, HIV/AIDS, depression, and/or sleep disorders.
↵%Based on the Medication Adherence Report Scale-5 (MARS-5) scale which measures participant-reported medication adherence, in reference to asthma medications in the context of the PREPARE trial. Mean scores are calculated from five items and range from 1 to 5, with higher scores indicating better adherence. Here low adherence was defined as scores <4.5 [Chan et al. Br J Clin Pharmacol 2020;86:1281-8].
Abbreviations: BHLS, Brief Health Literacy Screen27; BMI, body mass index; BMQ, Beliefs about Medicines Questionnaire28; ICS, inhaled corticosteroids.
- Table 3.
Asthma Control and Quality of Life Outcomes by Standard vs Nonstandard Inhaler Names
Non-Standard versus standard Inhaler Name Use Effect size 95% CI p-Value ACT −0.58 −1.12 to −0.04 0.0372 ASUI −0.04 −0.07 to −0.01 0.0022 APGAR 0.28 0.06 to 0.51 0.0142 Notes: Data shown compare asthma control and quality of life survey scores for participants who use non-standard inhaler names relative to those who use standard inhalers names. These are the results of multivariable linear regression models, controlling for age, gender, ethnicity, BMI, region, smoking environment, years diagnosed with asthma, and asthma controller regimen.
Abbreviations: ACT, Asthma Control Test®24; APGAR, asthma Activities, Persistent triGgers, Asthma medications and Response to therapy)32; ASUI, Asthma Symptom Utility Index33; BMI, body mass index; CI, confidence interval. The ACT is a self-administered survey that assesses asthma control levels, with total score ranging from 5 to 25, and a minimal clinically important difference of 3 points; scores of 20–25 indicate well-controlled asthma, 16–19 not well-controlled asthma, and 5–15 very poorly controlled asthma. The ASUI is a self-administered survey that assesses preference-based quality of life, with minimal clinically important difference of 0.09 points, and scores ranging from 0 (worst symptoms) to 1 (no symptoms). The asthma APGAR has 3 questions related to activity limitations and daytime and nighttime asthma symptoms, with total score ranging from 0 to 6, where a total score >2 represents uncontrolled asthma.
