ORIGINAL RESEARCH
Victoria E. Forth, MA, MMS, PA-C; Juan Carlos Cardet, MD, MPH; Ku-Lang Chang, MD; Brianna Ericson, MPH; Laura P. Hurley, MD, MPH; Nancy E. Maher, MPH; Elizabeth W. Staton, MSTC; Bonnie S. Telon Sosa, MPH; Elliot Israel, MD; on behalf of the PREPARE investigators
Corresponding Author: Elliot Israel, MD; Division of Pulmonary and Critical Care Medicine - Brigham and Women’s Hospital
Email: eisrael@bwh.harvard.edu
DOI: 10.3122/jabfm.2022.220270R2
Keywords: Asthma, Health Literacy, Inhalers, Outcomes Assessment, Physician-Patient Relations
Dates: Submitted: 08-05-2022; Revised: 11-08-2022; Accepted: 03-06-2023
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BACKGROUND: Clinician-patient miscommunication contributes to worse asthma outcomes. What patients call their asthma inhalers and its relationship with asthma morbidity are unknown.
METHODS: Inhaler names were ascertained from Black and Latinx adults with moderate-severe asthma and categorized as “standard” if based on brand/generic name or inhaler type (i.e., controller vs. rescue) or “non-standard” for other terms (i.e., color, device type, e.g., “puffer,” or unique names). Clinical characteristics and asthma morbidity measures were evaluated at baseline: self-reported asthma exacerbations one year before enrollment (i.e., systemic corticosteroid bursts, emergency department (ED)/urgent care (UC) visits, or hospitalizations), and asthma control and quality of life. Multivariable regression models tested the relationship between non-standard names and asthma morbidity measures, with adjustments.
RESULTS: Forty-four percent (502/1150) of participants used non-standard inhaler names. These participants were more likely to be Black (p=0.006), from the Southeast (p<0.001), and have fewer years with asthma (p=0.012) relative to those who used standard names. Non-standard inhaler names was associated with an incidence rate ratio (IRR) of 1.29 (95% confidence interval [CI] 1.11-1.50, p=0.001; 1.8 vs. 1.5 events) for corticosteroid bursts for asthma, an IRR=1.43 (95% CI 1.21-1.69, p<0.001; 1.9 vs. 1.4 events) for ED/UC visits for asthma, and an odds ratio=1.57 (95% CI 1.12-2.18, p=0.008; 0.5 vs. 0.3 events) for asthma hospitalizations after adjustment.
CONCLUSIONS: Patients who use non-standard names for asthma inhalers experience increased asthma morbidity. Ascertaining what patients call their inhalers may be a quick method to identify those at higher risk of poor outcomes.